John Brock-Utne

All Publications

• Bair Hugger: A potential enemy within the operating room. Infection control and hospital epidemiology Watkins, W. G., Jaffe, R. A., Brock-Utne, J. G. 2022: 1-2

  View details for DOI 10.1017/ice.2022.98

  View details for PubMedID 35485718

• Potential Sources of Operating Room Air Contamination: A Preliminary Study. The Journal of hospital infection Brock-Utne, J. G., Ward, J. T., Jaffe, R. A. 2021

  Abstract

  BACKGROUND: The Neptune surgical suction system (NSSS) and the Bair Hugger (BH) forced-air warmer both discharge filtered exhaust or heated air into the OR, often in close proximity to a surgical site.AIM: To assess the effectiveness of this filtration, we examined the quantity and identity of microbial colonies emitted from their output ports compared to those obtained from circulating air entering the OR.METHODS: Air samples were collected from each device using industry standard sampling devices in which a measured volume of air is impacted onto a blood agar plate at a controlled flow rate. Twelve ORs were studied. Sample plates were incubated for one week per study protocol, then interpreted for colony counts and sent for species identification.FINDINGS: The average colony count from the NSSS exhaust was not significantly different from that obtained from room air samples, however the average count from the BH output was significantly higher (p=0.0086) than room air. Genetic identification profiles revealed the presence of environmental or commensal organisms that differed depending on the source. High variability in colony counts from both devices suggests that certain NSSS and BH devices could be significant sources of OR air contamination.CONCLUSIONS: Our study showed that the BH patient warming device could be a source of airborne microbial contamination in the OR and that individual BH and NSSS units exhibit a higher output of microbial CFUs than would be expected compared to incoming room air. We make simple suggestions on ways to mitigate these risks.

  View details for DOI 10.1016/j.jhin.2021.04.020

  View details for PubMedID 33895163

• Rapid Blood Transfusion: The Importance of Hemodilution and Needleless Connectors CUREUS Burbridge, M. A., Panigrahi, A. K., Stone, S. A., Jaffe, R. A., Brock-Utne, J. 2021; 13 (3)

  View details for DOI 10.7759/cureus.13999

  View details for Web of Science ID 000631196700013

• Rapid Blood Transfusion: The Importance of Hemodilution and Needleless Connectors. Cureus Burbridge, M. A., Panigrahi, A. K., Stone, S. A., Jaffe, R. A., Brock-Utne, J. 2021; 13 (3): e13999

  Abstract

   Large-bore cannulas are critical to administering IV fluids and blood products during resuscitation and treatment of hemorrhage. Although catheter flow rates for crystalloid solutions are well defined, rapid administration of blood products is poorly characterized. In this in vitro study, we examined the effects of hemodilution and needleless connectors on red blood cell (RBC) flow rates. To determine RBC flow rates through large-bore cannulae, a crystalloid solution (Normosol®, Hospira, Lake Forest, IL) or RBC units were warmed and delivered under pressure (360 mmHg) using a Level 1 H-1200 Fast Flow Fluid Warmer (Smiths Medical, St. Paul, MN). Flow rates for crystalloid, packed RBCs and diluted RBCs were determined using a stopwatch. Additionally, the effect of the MaxPlus® clear needleless connector (CareFusion, San Diego, CA) was measured in all three infusion groups. Flow rates for undiluted RBC units were 53% slower than crystalloid solution (220 mL/min vs. 463 mL/min; p=0.0003), however, when RBC units were diluted to a hematocrit of ~30% flow rate improved to 369 mL/min (p=0.005). The addition of the MaxPlus® needleless connector reduced flow of crystalloid solution by 47% (245 mL/min; p=0.0001), undiluted RBCs by 64% (78 mL/min; p=0.01), and diluted RBCs by 51% (180 mL/min; p=0.00003). Compared to undiluted RBC units, hemodilution increased RBC delivery rate through a MaxPlus® connector by 130% (p=0.004) and by 68% (p=0.02) when the catheter was directly connected to the Level 1 tubing (MaxPlus® excluded). In settings requiring rapid transfusion of RBC units, needleless connectors should not be used and hemodilution should be considered in order to decrease the time required to deliver an equivalent red cell mass.

  View details for DOI 10.7759/cureus.13999

  View details for PubMedID 33880314

  View details for PubMedCentralID PMC8053387

• 100% Nitrous Oxide in the Oxygen Line: How Could This Happen in a Modern Anesthesia Machine? A&A practice Joo, S. S., Bechtold, H., Jaffe, R. A., Brock-Utne, J. G. 2020; 14 (13): e01337

  Abstract

  The inadvertent crossover between O2 and N2O pipelines has become extremely rare in practice. We describe a case where it was possible to ventilate with 100% N2O instead of the intended 100% O2 on a modern anesthesia delivery system (Drager Apollo; Dragerwerk AG & Co KgaA, Lubeck, Germany). This was the result of the incorrect assembly of diameter index safety system (DISS) components during preventative maintenance that defeated the DISS failsafe system. To make incorrect assembly easier to avoid, DISS component labeling could be more prominent and color-coded, or the internal construction of the gas manifold could incorporate DISS.

  View details for DOI 10.1213/XAA.0000000000001337

  View details for PubMedID 33185408

• Address Physician Burnout by Restoring Control of Health Care to Physicians. JAMA internal medicine Brock-Utne, J. G., Jaffe, R. A. 2020; 180 (2): 334

  View details for DOI 10.1001/jamainternmed.2019.6007

  View details for PubMedID 32011631

• Feasibility study of a smartphone pupillometer and evaluation of its accuracy. Journal of clinical monitoring and computing Neice, A. E., Fowler, C. n., Jaffe, R. A., Brock-Utne, J. G. 2020

  Abstract

  Measurement of pupillary characteristics, such as pupillary unrest in ambient light, and reflex dilation have been shown to be useful in a variety of clinical situations. Dedicated pupillometers typically capture images in the near-infrared to allow imaging in both light and darkness. However, because a subset of pupillary measurements can be acquired with levels of visible light suitable for conventional cameras, it is theoretically possible to capture data using general purpose cameras and computing devices such as those found on smartphones. Here we describe the development of a smartphone-based pupillometer and compare its performance with a commercial pupillometer. Smartphone pupillometry software was developed and then compared with a commercial pupillometer by performing simultaneous scans in both eyes, using the smartphone pupillometer and a commercial pupillometer. The raw scans were compared, as well as a selected pupillary index: pupillary unrest in ambient light. In 77% of the scans the software was able to successfully identify the pupil and iris. The raw data as well as calculated values of pupillary unrest in ambient light were in clinically acceptable levels of agreement; Bland-Altman analysis of raw pupil measurements yielded a 95% confidence interval of 0.26 mm. In certain situations a smartphone pupillometer may be an appropriate alternative to a commercial pupillometer.

  View details for DOI 10.1007/s10877-020-00592-x

  View details for PubMedID 32951188

• Pennywise and a Pound Foolish: The Advantage of Dantrolene Nanosuspension (Ryanodex) in the Treatment of Malignant Hyperthermia. Anesthesia and analgesia McAvoy, J. C., Brodsky, J. B., Brock-Utne, J. 2019

  View details for DOI 10.1213/ANE.0000000000004448

  View details for PubMedID 31633504

• The use of end-tidal argon to detect venous air embolism: foiled by "fake oxygen!" JOURNAL OF CLINICAL MONITORING AND COMPUTING McAvoy, J., Jaffe, R., Burbridge, M., Schertz, T., Brock-Utne, J. 2019; 33 (5): 925–26

  View details for DOI 10.1007/s10877-018-0223-3

  View details for Web of Science ID 000482910800024

• Predictors of post-anaesthesiology residency research productivity: preliminary report. British journal of anaesthesia Haight, E. S., Chen, F., Tanaka, P., Brock-Utne, J. G., Macario, A., Sun, E. C., Tawfik, V. L. 2019

  View details for DOI 10.1016/j.bja.2019.07.018

  View details for PubMedID 31474349

• Misinterpretation of USP 797 Continues. Anesthesia and analgesia Brock-Utne, J. G., Jaffe, R. A. 2019

  View details for DOI 10.1213/ANE.0000000000004390

  View details for PubMedID 31453866

• Cerebral Oximetry Fails as a Monitor of Brain Perfusion in Cardiac Surgery: A Case Report A & A PRACTICE McAvoy, J., Jaffe, R., Brock-Utne, J., Lopez, J., Brodt, J. 2019; 12 (12): 441–43

  View details for DOI 10.1213/XAA.0000000000000963

  View details for Web of Science ID 000473709400008

• Cerebral Oximetry Fails as a Monitor of Brain Perfusion in Cardiac Surgery: A Case Report. A&A practice McAvoy, J., Jaffe, R., Brock-Utne, J., Lopez, J., Brodt, J. 2019

  Abstract

  Cerebral oximetry is commonly being advocated as a monitor for regional cerebral tissue oxygenation during cardiac surgery. We have increasing concern about the accuracy of this monitor, including the current systems entering the market, with new probes and algorithms. We present 2 cases where cerebral oximetry failed to accurately portray cerebral oxygenation. In the current form, cerebral oximetry may at best be an expensive tool without any benefit on outcomes. In addition, it may contribute to misleading and confusing clinical data.

  View details for PubMedID 30663993

• Performance of Litholyme compared with Sodasorb carbon dioxide absorbents in a standard clinical setting. British journal of anaesthesia Fowler, C. J., Burbridge, M. A., Jaffe, R. A., Brock-Utne, J. G. 2019; 122 (1): e11–e12

  View details for DOI 10.1016/j.bja.2018.09.015

  View details for PubMedID 30579416

• Pennywise and a Pound Foolish: The Advantage of Dantrolene Nanosuspension (Ryanodex) in the Treatment of Malignant Hyperthermia. Anesthesia and analgesia McAvoy, J. C., Brodsky, J. B., Brock-Utne, J. n. 2019; 129 (6): e201–e202

  View details for DOI 10.1213/ANE.0000000000004448

  View details for PubMedID 31743207

• Performance of Litholyme (TM) compared with Sodasorb (TM) carbon dioxide absorbents in a standard clinical setting BRITISH JOURNAL OF ANAESTHESIA Fowler, C. J., Burbridge, M. A., Jaffe, R. A., Brock-Utne, J. G. 2019; 122 (1): E11–E12

  View details for DOI 10.1016/j.bja.2018.10.023

  View details for Web of Science ID 000453927600009

• An Anesthesia Attempt to Be Green: How Do You Waste Your Carbon Dioxide Absorbers? A&A practice Burbridge, M. A., Chua, P. n., Jaffe, R. A., Pearl, R. G., Brock-Utne, J. G. 2019

  Abstract

  Operating room waste is categorized as noncontaminated solid waste (SW) and regulated medical waste (RMW). RMW is treated by autoclaving at an increased economic and environmental cost. We evaluated these costs with a focus on the disposable carbon dioxide (CO2) absorbers. At our institution, exhausted CO2 absorbers were discarded as RMW. We collaborated with product representatives, anesthesia and perioperative staff, and waste management personnel to identify opportunities and barriers for recycling and waste reduction. Ultimately, we agreed to discard CO2 absorbers as SW instead of RMW, a strategy that is practical, less expensive, and more environmentally appropriate.

  View details for DOI 10.1213/XAA.0000000000001113

  View details for PubMedID 31609724

• Inaccurate Blood Pressure Readings in the Intensive Care Unit: An Observational Study. Cureus Tse, B., Burbridge, M. A., Jaffe, R. A., Brock-Utne, J. 2018; 10 (12): e3716

  Abstract

  Measuring and monitoring cerebral perfusion pressure (CPP) is important in the management of patients with certain neurological conditions. To accurately reflect blood pressure at the circle of Willis, the arterial line transducer should be leveled at the tragus. This study measured the relative distance of the transducer to the tragus in 100 intensive care unit (ICU) patients in the mixed ICU at our institution, of which 44 patients had a pressure-sensitive neurological diagnosis. For neurological patients, the average distance was 10.9 cm and for non-neurological patients, the average distance was 11.4 cm (p-value: 0.60). This suggests that the arterial line transducer was leveled at approximately the same level regardless of pathology, potentially leading to falsely elevated CPP readings in patients with pressure-sensitive neurological pathology.

  View details for PubMedID 30906677

• Spiking of intravenous bags does not cause time-dependent microbial contamination: a preliminary report INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY Brock-Utne, J. G., Smith, S. C., Banaei, N., Chang, S., Alejandro-Harper, D., Jaffe, R. A. 2018; 39 (9): 1129–30

  View details for DOI 10.1017/ice.2018.143

  View details for Web of Science ID 000444805900020

• Central Venous Lines in Low-birth-weight Newborns: Watch Out. Anesthesiology Brock-Utne, J. G. 2018; 129 (2): 387

  View details for PubMedID 30020190

• Central Venous Lines in Low-birth-weight Newborns: Watch Out ANESTHESIOLOGY Brock-Utne, J. G. 2018; 129 (2): 387

  View details for DOI 10.1097/ALN.0000000000002285

  View details for Web of Science ID 000438922500043

• Spiking of intravenous bags does not cause time-dependent microbial contamination: a preliminary report. Infection control and hospital epidemiology Brock-Utne, J. G., Smith, S. C., Banaei, N., Chang, S., Alejandro-Harper, D., Jaffe, R. A. 2018: 1–2

  View details for PubMedID 29961441

• AN ANESTHETIC ATTEMPT TO BE GREEN: HOW DO YOU WASTE YOUR CO2 ABSORBERS? Chua, P., Brock-Utne, J., Burbridge, M. A., Pearl, R., Alejandro-Harper, D., Kimball, E., Gilsenan, C. LIPPINCOTT WILLIAMS & WILKINS. 2018: 226–27

  View details for Web of Science ID 000460106500120

• Nonpharmacologic Management of Acute Singultus (Hiccups) ANESTHESIA AND ANALGESIA Orlovich, D. S., Brodsky, J. B., Brock-Utne, J. G. 2018; 126 (3): 1091

  View details for PubMedID 29324501

• The use of end-tidal argon to detect venous air embolism: foiled by "fake oxygen!" Journal of clinical monitoring and computing McAvoy, J. n., Jaffe, R. n., Burbridge, M. n., Schertz, T. n., Brock-Utne, J. n. 2018

  Abstract

  Venous air-embolism (VAE) potentially catastrophic complication surgery. Based on previous data using changes in end-tidal nitrogen as an indicator of VAE, we surmised that changes in end-tidal argon (EtAr) may be an indicator of VAE. We sought to determine if a commercial mass-spectrometer (PCT Proline Analyzer 61700-8 Class 85, Ametek, Pittsburgh, PA 15238) could be used to detect changes in EtAr in an invitro model. A Drager Apollo™ (Drager, Lubeck, Germany) anesthesia machine was used to ventilate a dummy lung (2 L bag) with a minute ventilation of 6 L/min in 100% oxygen. The quadrupole mass-spectrometer (sampling at 0.0004 atm-cc/sec) was attached to the end-tidal inlet of the machine. Room air (1-60 mL) was injected into the dummy lung to simulate VAE. A strong baseline ion-current (1.2 × 10-12 amps) of argon was noted. Due to this contamination we were unable to detect "VAE" events of injected air. Argon represents approximately 0.93% of room air, or about 9300 parts per million (ppm). We detected about 2000 ppm argon in medical-grade oxygen (or 0.2%), limiting our ability to detect changes in EtAr. This is a USP-accepted contaminant, rendering this technology is insensitive for early, rapid detection of VAE. We assumed medical grade oxygen was pure and were surprised to learn otherwise. We want to share this likely largely unknown finding with the medical community.

  View details for PubMedID 30467672

• A novel thermal compression device for perioperative warming: a randomized trial for feasibility and efficacy BMC ANESTHESIOLOGY Maria, P., Maria, C., Eisenried, A., Velasquez, N., Kannard, B., Ramani, A., Kahn, D., Wheeler, A., Brock-Utne, J. 2017; 17: 102

  Abstract

  Inadvertent perioperative hypothermia (IPH) leads to surgical complications and increases length of stay. IPH rates are high with the current standard of care, forced air warming (FAW). Our hypothesis is that a prototype thermal compression device that heats the popliteal fossa and soles of the feet, with lower leg compression, increases perioperative temperatures and reduces IPH compared to the current standard of care.Thirty six female breast surgery patients, at a tertiary academic hospital, were randomized to the device or intraoperative FAW (stage I) with a further 18 patients randomized to the device with a single heating area only (stage II, popliteal fossa or sole of the feet). Stage I: 37 patients recruited (final 36). Stage II: 18 patients recruited (final 18).general anesthesia with esophageal monitoring for over 30 min, legs available and able to fit the device and no contraindications to leg heating or compression. The intervention was: Stage I: Investigational prototype thermal compression device (full device group) or intraoperative FAW. Stage II: Device with only a single heating location. Primary outcomes were perioperative temperatures and incidence of IPH. Secondary outcomes were local skin temperature, general and thermal comfort scores and presence of perioperative complications, including blood loss.Mean temperatures in the full device group were significantly higher than the FAW group in the pre-operative (36.7 vs 36.4 °C, p < 0.001), early intraoperative (36.3 vs 35.9 °C, p < 0.001), intraoperative (36.6 vs 36.2 °C, p < 0.001) and postoperative periods (36.8 vs 36.5 °C, p < 0.001). The incidence of IPH in the device group was also significantly lower (16.7% vs 72.0%, p = 0.001). Thermal comfort scores were significantly higher in the full device group and hypothermia associated wound complications were higher in the FAW group.The thermal compression device is feasible and has efficacy over the FAW. Further studies are recommended to investigate clinically significant outcomes.clinicaltrials.gov ( NCT02155400 ).

  View details for PubMedID 28800725

• Overregulation Revisited ANESTHESIA AND ANALGESIA Brock-Utne, J. G., Sanford, J., Jaffe, R. A. 2017; 124 (5): 1743

  View details for PubMedID 28426591

• Capnoperitoneum During Peroral Endoscopic Myotomy-Recognition and Management: A Case Report. A & A case reports Lee, E., Brodsky, J. B., Rivas, H., Zheng, K., Brock-Utne, J. G. 2017

  Abstract

  Peroral endoscopic myotomy (POEM) is a minimally invasive procedure for treating esophageal achalasia. During POEM, carbon dioxide is insufflated under pressure into the esophagus and stomach, which can cause clinically significant capnoperitoneum, capnomediastinum, or capnothorax. We present a case in which gas accumulation in the abdomen during POEM had adverse effects on ventilation. Once the cause was recognized, needle decompression of the abdomen led to immediate improvement in ventilation.

  View details for DOI 10.1213/XAA.0000000000000449

  View details for PubMedID 28114155

• The Importance of Developing Standardized Transparent Validation of Large Data ANESTHESIA AND ANALGESIA Sanford, J., Jaffe, R. A., Kadry, B., Bjerregaard, J., Schmiesing, C., Brock-Utne, J. G. 2016; 123 (6): 1636–37

  View details for PubMedID 27655275

• The impact of blood pressure cuff location on the accuracy of noninvasive blood pressure measurements in obese patients: an observational study CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE Anast, N., Olejniczak, M., Ingrande, J., Brock-Utne, J. 2016; 63 (3): 298-306

  Abstract

  Obesity presents many challenges to the anesthesiologist, including poorly fitting blood pressure (BP) cuffs due to the conical shape of the upper arm. The aim of this study was to determine the accuracy of noninvasive BP readings, obtained from a noninvasive BP cuff using various cuff locations and wrapping techniques, compared with invasive intra-arterial BP readings.Thirty American Society of Anesthesiologists physical status I-III obese (body mass index > 30 kg·m(-2)) individuals undergoing non-cardiac surgery were enrolled in this observational study. Serial oscillometric noninvasive BP (NIBP) measurements were taken in the patients' forearm and upper arm with two different wrapping formations (one following the contour of the upper arm, the other keeping cuff edges parallel). These NIBP measurements were compared with invasive arterial blood pressure (ABP) measurements taken from the ipsilateral radial artery. The precision and bias of the NIBP and ABP measurements were determined using Bland-Altman analysis. Analysis of variance and Welch's t test were used to determine between-group differences in bias.There was poor agreement between the ABP measurements and all types of NIBP measurements. Each of our study participants had a least one NIBP parameter (mean arterial pressure, systolic BP, or diastolic BP) that was > 10 mmHg different than the corresponding ABP parameter. Upper arm BP measurements showed a statistically insignificant trend toward underestimating ABP. For all cuff positions and wrapping techniques, systolic BP offered the best agreement between NIBP and ABP measurements.All the forms of NIBP cuff orientation studied had unacceptable precision and bias compared with invasive ABP measurements. When patient and/or surgical conditions necessitate accurate BP monitoring, direct arterial measurement should be considered over NIBP measurements in obese patients.

  View details for DOI 10.1007/s12630-015-0509-6

  View details for Web of Science ID 000370171300010

• The impact of blood pressure cuff location on the accuracy of noninvasive blood pressure measurements in obese patients: an observational study. Canadian journal of anaesthesia = Journal canadien d'anesthesie Anast, N., Olejniczak, M., Ingrande, J., Brock-Utne, J. 2016; 63 (3): 298-306

  Abstract

  Obesity presents many challenges to the anesthesiologist, including poorly fitting blood pressure (BP) cuffs due to the conical shape of the upper arm. The aim of this study was to determine the accuracy of noninvasive BP readings, obtained from a noninvasive BP cuff using various cuff locations and wrapping techniques, compared with invasive intra-arterial BP readings.Thirty American Society of Anesthesiologists physical status I-III obese (body mass index > 30 kg·m(-2)) individuals undergoing non-cardiac surgery were enrolled in this observational study. Serial oscillometric noninvasive BP (NIBP) measurements were taken in the patients' forearm and upper arm with two different wrapping formations (one following the contour of the upper arm, the other keeping cuff edges parallel). These NIBP measurements were compared with invasive arterial blood pressure (ABP) measurements taken from the ipsilateral radial artery. The precision and bias of the NIBP and ABP measurements were determined using Bland-Altman analysis. Analysis of variance and Welch's t test were used to determine between-group differences in bias.There was poor agreement between the ABP measurements and all types of NIBP measurements. Each of our study participants had a least one NIBP parameter (mean arterial pressure, systolic BP, or diastolic BP) that was > 10 mmHg different than the corresponding ABP parameter. Upper arm BP measurements showed a statistically insignificant trend toward underestimating ABP. For all cuff positions and wrapping techniques, systolic BP offered the best agreement between NIBP and ABP measurements.All the forms of NIBP cuff orientation studied had unacceptable precision and bias compared with invasive ABP measurements. When patient and/or surgical conditions necessitate accurate BP monitoring, direct arterial measurement should be considered over NIBP measurements in obese patients.

  View details for DOI 10.1007/s12630-015-0509-6

  View details for PubMedID 26475165

• In Response. Anesthesia and analgesia Downey, L., Blaine, K., Sliwa, J., Macario, A., Brock-Utne, J. 2015; 121 (4): 1113-?

  View details for DOI 10.1213/ANE.0000000000000827

  View details for PubMedID 26378711

• A Case Illustrating the Costs of Quality Improvement: Nine Months to Move Needles and Syringes on the Anesthesia Cart. A & A case reports Quick, A. K., Macario, A., Brock-Utne, J. G., Jaffe, R. A., Kadry, B. 2015; 5 (5): 88-90

  Abstract

  Powerful entities are pushing physicians to become more involved with quality improvement (QI). We report a QI project to standardize and improve the ergonomics of the anesthesia medication and supply cart. Simply obtaining approval to make minor changes to the cart involved 54 phone calls, 164 e-mails, 4 presentations, 2 forms, 9 meetings, and 4 months of time. Confusion over fiscal matters further delayed the project by an additional 3 months. A combination of competing regulations, administrative overprocessing, and the lack of dedicated QI financial resources made simple improvements a challenge. The costs of participating in QI deserve attention.

  View details for DOI 10.1213/XAA.0000000000000148

  View details for PubMedID 26323036

• Delayed emergence after anesthesia JOURNAL OF CLINICAL ANESTHESIA Tzabazis, A., Miller, C., Dobrow, M. F., Zheng, K., Brock-Utne, J. G. 2015; 27 (4): 353-360

  Abstract

  In most instances, delayed emergence from anesthesia is attributed to residual anesthetic or analgesic medications. However, delayed emergence can be secondary to unusual causes and present diagnostic dilemmas. Data from clinical studies is scarce and most available published material is comprised of case reports. In this review, we summarize and discuss less common and difficult to diagnose reasons for delayed emergence and present cases from our own experience or reference published case reports/case series. The goal is to draw attention to less common reasons for delayed emergence, identify patient populations that are potentially at risk and to help anesthesiologists identifying a possible cause why their patient is slow to wake up.

  View details for DOI 10.1016/j.jclinane.2015.03.023

  View details for Web of Science ID 000355896400013

• Delayed emergence after anesthesia. Journal of clinical anesthesia Tzabazis, A., Miller, C., Dobrow, M. F., Zheng, K., Brock-Utne, J. G. 2015; 27 (4): 353-360

  Abstract

  In most instances, delayed emergence from anesthesia is attributed to residual anesthetic or analgesic medications. However, delayed emergence can be secondary to unusual causes and present diagnostic dilemmas. Data from clinical studies is scarce and most available published material is comprised of case reports. In this review, we summarize and discuss less common and difficult to diagnose reasons for delayed emergence and present cases from our own experience or reference published case reports/case series. The goal is to draw attention to less common reasons for delayed emergence, identify patient populations that are potentially at risk and to help anesthesiologists identifying a possible cause why their patient is slow to wake up.

  View details for DOI 10.1016/j.jclinane.2015.03.023

  View details for PubMedID 25912729

• Risk factors for respiratory depression in patients undergoing retrobulbar block for vitreoretinal surgery. Ophthalmic surgery, lasers & imaging retina Silva, R. A., Leng, J. C., He, L., Brock-Utne, J. G., Drover, D. R., Leng, T. 2015; 46 (2): 243-247

  Abstract

  To determine the risk factors for respiratory depression during retrobulbar block administration before vitreoretinal surgery.Prospective, observational case series of 113 patients undergoing monitored anesthesia care and retrobulbar block before vitreoretinal surgery at a tertiary medical center.Chin lift, jaw thrust, and bag mask ventilation were performed in eight (7.1%), nine (8%), and six (5.3%) patients, respectively. No patients required intubation. Age, sex, body mass index, history of obstructive sleep apnea, American Society of Anesthesiologists physical status level, and baseline oxygen saturation were not predictive of airway intervention. Of the four anesthetic agents utilized (midazolam, fentanyl, alfentanil, and propofol), only propofol and fentanyl were associated with an increased risk for clinically significant apnea. Use of three medications for sedation was associated with a 5.4-fold increase in the relative risk of requiring a respiratory rescue intervention.During preoperative sedation for retrobulbar block administration, the use of propofol, fentanyl, or a combination of three anesthetics is associated with a statistically significant increase in the risk for respiratory depression requiring resuscitation. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:243-247.].

  View details for DOI 10.3928/23258160-20150213-22

  View details for PubMedID 25707051

• Risk Factors for Respiratory Depression in Patients Undergoing Retrobulbar Block for Vitreoretinal Surgery OPHTHALMIC SURGERY LASERS & IMAGING RETINA Silva, R. A., Leng, J. C., He, L., Brock-Utne, J. G., Drover, D. R., Leng, T. 2015; 46 (2): 243-247

  Abstract

  To determine the risk factors for respiratory depression during retrobulbar block administration before vitreoretinal surgery.Prospective, observational case series of 113 patients undergoing monitored anesthesia care and retrobulbar block before vitreoretinal surgery at a tertiary medical center.Chin lift, jaw thrust, and bag mask ventilation were performed in eight (7.1%), nine (8%), and six (5.3%) patients, respectively. No patients required intubation. Age, sex, body mass index, history of obstructive sleep apnea, American Society of Anesthesiologists physical status level, and baseline oxygen saturation were not predictive of airway intervention. Of the four anesthetic agents utilized (midazolam, fentanyl, alfentanil, and propofol), only propofol and fentanyl were associated with an increased risk for clinically significant apnea. Use of three medications for sedation was associated with a 5.4-fold increase in the relative risk of requiring a respiratory rescue intervention.During preoperative sedation for retrobulbar block administration, the use of propofol, fentanyl, or a combination of three anesthetics is associated with a statistically significant increase in the risk for respiratory depression requiring resuscitation. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:243-247.].

  View details for DOI 10.3928/23258160-20150213-22

  View details for Web of Science ID 000353360100013

  View details for PubMedID 25707051

• Positive end-expiratory pressure to increase internal jugular vein size is poorly tolerated in obese anesthetized adults. Anesthesia and analgesia Downey, L. A., Blaine, K. P., Sliwa, J., Macario, A., Brock-Utne, J. 2014; 119 (3): 619-621

  Abstract

  Central venous cannulation is technically challenging in obese patients. We hypothesized that positive end-expiratory pressure (PEEP) increases the size of the internal jugular vein (IJV) in obese adults.The circumference and cross-sectional area of the IJV were measured in obese patients under general anesthesia at PEEP 0, 5, and 10 cm H2O. Results are reported as means ± SE.PEEP at 10 cm H2O was tolerated by 18 of 24 obese patients. Each 5 cm H2O of PEEP increased the cross-sectional area by 0.16 ± 0.02 cm (P < 0.0001) and the circumference by 0.23 ± 0.03 cm (P < 0.0001).PEEP modestly increases the size of the IJV in obese adults but was poorly tolerated because of hypotension.

  View details for DOI 10.1213/ANE.0000000000000347

  View details for PubMedID 25137000

• Can Preoperative Betaxolol Eye Drops Reduce the Incidence of Postoperative Visual Loss (POVL)? Journal of neurosurgical anesthesiology Zheng, K., Brock-Utne, J. G. 2014; 26 (3): 271-?

  View details for DOI 10.1097/ANA.0000000000000025

  View details for PubMedID 24275939

• Comment on Hurley, J.C. Towards Clinical Application of Anti-endotoxin Antibodies; A Re-Appraisal of the Disconnect. Toxins 2013, 5, 2589-2620 TOXINS Brock-Utne, J. G. 2014; 6 (4): 1362–63

  View details for PubMedID 24732205

• Intraoperative hyperthermia during cesarean section: a pertinent lesson INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA Firago, V., Brock-Utne, J. G. 2014; 23 (1): 96–97

  View details for PubMedID 23954017

• A word of warning when working in the Third World ACTA ANAESTHESIOLOGICA SCANDINAVICA Brock-Utne, J. G. 2014; 58 (1): 128

  View details for DOI 10.1111/aas.12225

  View details for Web of Science ID 000328156800019

  View details for PubMedID 24341696

• Positive end-expiratory pressure to increase internal jugular vein size is poorly tolerated in obese anesthetized adults Anesthesia Analgesia Downey, L., Blaine, K., Sliwa, J., Macario, A., brock-Utne, J. 2014; 119 (3): 619-621

  Abstract

  Central venous cannulation is technically challenging in obese patients. We hypothesized that positive end-expiratory pressure (PEEP) increases the size of the internal jugular vein (IJV) in obese adults.The circumference and cross-sectional area of the IJV were measured in obese patients under general anesthesia at PEEP 0, 5, and 10 cm H2O. Results are reported as means ± SE.PEEP at 10 cm H2O was tolerated by 18 of 24 obese patients. Each 5 cm H2O of PEEP increased the cross-sectional area by 0.16 ± 0.02 cm (P < 0.0001) and the circumference by 0.23 ± 0.03 cm (P < 0.0001).PEEP modestly increases the size of the IJV in obese adults but was poorly tolerated because of hypotension.

  View details for DOI 10.1213/ANE.0000000000000347

• Did You Know This About Your Lead Apron? ANESTHESIA AND ANALGESIA Tan, J., Brock-Utne, J. G. 2013; 117 (2): 534–35

  View details for DOI 10.1213/ANE.0b013e31829c6527

  View details for Web of Science ID 000326511500041

  View details for PubMedID 23881379

• POSITIVE END EXPIRATORY PRESSURE INCREASES INTERNAL JUGULAR VEIN CROSS-SECTIONAL AREA IN OBESE ANESTHETIZED ADULTS Downey, L. A., Silwa, J., Brock-Utne, J., Macario, A. LIPPINCOTT WILLIAMS & WILKINS. 2013: 218

  View details for Web of Science ID 000330441700188

• Letter to Editor: Be aware when you are attending an industry sponsored medical lecture. CSA Bulletin Singleton M, Brock-Utne JG 2013
• Abstract: Positive end expiratory pressure increases internal jugular vein cross-sectional area in obese anesthetized adults. International Anesthesia Research Society Downey L, Sliwa J, Blaine K, Macario A, Brock-Utne JG 2013
• Letter to Editor: Did you know this about your lead apron? Anesthesia & Analgesia Tan JP, Brock-Utne JG 2013
• A safety suggestion when using a soft bite block PEDIATRIC ANESTHESIA Brock-Utne, J. G., Jaffe, R. A. 2012; 22 (11): 1145-1145

  View details for DOI 10.1111/pan.12002

  View details for Web of Science ID 000310802400022

• A safety suggestion when using a soft bite block. Paediatric anaesthesia Brock-Utne, J. G., Jaffe, R. A. 2012; 22 (11): 1145

  View details for DOI 10.1111/pan.12002

  View details for PubMedID 25631701

• Preliminary Study of Ergonomic Behavior During Simulated Ultrasound-Guided Regional Anesthesia Using a Head-Mounted Display JOURNAL OF ULTRASOUND IN MEDICINE Udani, A. D., Harrison, T. K., Howard, S. K., Kim, T. E., Brock-Utne, J. G., Gaba, D. M., Mariano, E. R. 2012; 31 (8): 1277-1280

  Abstract

  A head-mounted display provides continuous real-time imaging within the practitioner's visual field. We evaluated the feasibility of using head-mounted display technology to improve ergonomics in ultrasound-guided regional anesthesia in a simulated environment. Two anesthesiologists performed an equal number of ultrasound-guided popliteal-sciatic nerve blocks using the head-mounted display on a porcine hindquarter, and an independent observer assessed each practitioner's ergonomics (eg, head turning, arching, eye movements, and needle manipulation) and the overall block quality based on the injectate spread around the target nerve for each procedure. Both practitioners performed their procedures without directly viewing the ultrasound monitor, and neither practitioner showed poor ergonomic behavior. Head-mounted display technology may offer potential advantages during ultrasound-guided regional anesthesia.

  View details for Web of Science ID 000306985100017

  View details for PubMedID 22837293

• Paralyzed by beauty JOURNAL OF CLINICAL ANESTHESIA Brun, C., Brock-Utne, J. G. 2012; 24 (1): 77–78

  View details for DOI 10.1016/j.jclinane.2011.09.002

  View details for Web of Science ID 000300141700020

  View details for PubMedID 22227161

• Letter to Editor: A safety suggestion when usina a soft bite block Pediatric Anesthesia Brock-Utne JG, Jaffe RA 2012; 22: 1145
• Abstract: Endotracheal tube cuff pressures: Are experienced anesthesiologists better? American Society of Anesthesiologists Chen M, Brock-Utne JG, Jaffe RA 2012
• Preliminary study of ergonomic behavior during simulated Ultrasound-guided Regional Anesthesia using head-mounted display. J Ultrasound Med Udani AD, Harrison TK, Howard SK, Kim TE, Brock-Utne JG, Gaba DM, Mariano ER 2012; 31 (8): 1277-80
• Abstract: Is there an optimum location to measure non-invasive blood pressure in morbidly obese patients? American Society of Anesthesiologists Anast N, Olejniczak M, Brock-Utne JG, Ingrande J, Jaffe RA, Lemmens H 2012
• Letter to Editor: Paralyzed by beauty. J of Clinical Anesthesia Brun C, Brock-Utne JG 2012; 24 (1): 77-78
• Human Subthalamic Neuron Spiking Exhibits Subtle Responses to Sedatives ANESTHESIOLOGY MacIver, M. B., Bronte-Stewart, H. M., Henderson, J. M., Jaffe, R. A., Brock-Utne, J. G. 2011; 115 (2): 254-264

  Abstract

  During deep brain stimulation implant surgery, microelectrode recordings are used to map the location of targeted neurons. The effects produced by propofol or remifentanil on discharge activity of subthalamic neurons were studied intraoperatively to determine whether they alter neuronal activity.Microelectrode recordings from 11 neurons, each from individual patients, were discriminated and analyzed before and after administration of either propofol or remifentanil. Subthalamic neurons in rat brain slices were recorded in patch-clamp to investigate cellular level effects.Neurons discharged at 42 ± 9 spikes/s (mean ± SD) and showed a common pattern of inhibition that lasted 4.3 ms. Unique discharge profiles were evident for each neuron, seen using joint-interval analysis. Propofol (intravenous bolus 0.3 mg/kg) produced sedation, with minor effects on discharge activity (less than 2.0% change in frequency). A prolongation of recurrent inhibition was evident from joint-interval analysis, and propofol's effect peaked within 2 min, with recovery evident at 10 min. Subthalamic neurons recorded in rat brain slices exhibited inhibitory synaptic currents that were prolonged by propofol (155%) but appeared to lack tonic inhibitory currents. Propofol did not alter membrane potential, membrane resistance, current-evoked discharge, or holding current during voltage clamp. Remifentanil (0.05 mg/kg) had little effect on overall subthalamic neuron discharge activity and did not prolong recurrent inhibition.These results help to characterize the circuit properties and feedback inhibition of subthalamic neurons and demonstrate that both propofol and remifentanil produce only minor alterations of subthalamic neuron discharge activity that should not interfere with deep brain stimulation implant surgery.

  View details for PubMedID 21701380

• Failure to Ventilate with the Drager Apollo (R) Anesthesia Workstation ANESTHESIOLOGY Hilton, G., Moll, V., Zumaran, A. A., Jaffe, R. A., Brock-Utne, J. G. 2011; 114 (5): 1238-1240

  View details for Web of Science ID 000289980200029

  View details for PubMedID 21430517

• The IRB Process Needs to Be Reexamined ANESTHESIA AND ANALGESIA Esaki, R., Macario, A., Harrison, T. K., Brock-Utne, J. G. 2011; 112 (5): 1249-1250

  View details for DOI 10.1213/ANE.0b013e31821224d5

  View details for Web of Science ID 000289785100046

  View details for PubMedID 21515655

• Abstract: No laughing matter: Inadvertent exposure to waste anesthetic gas due to machine failure. Is there a solution? American Society of Anesthesiologists Reid, C., Brun C, Brock-Utne JG 2011
• Case studies of near misses in clinical anesthesia. Springer Brock-Utne JG 2011
• Letter to Editor: The IRB process needs to be re-examined. Anesthesia & Analgesia Esaki R, Macario A, Harrison K, Brock-Utne JG 2011; 112: 1249-1250
• Abstract: Discard volume from blood sampling: What is the correct amount? American Society of Anesthesiologists Brock-Utne JG, Bradley J, Jaffe RA 2011
• Abstract: A critical incident in anesthetic machines. (Different countries have different electrical standards) American Society of Anesthesiologists Hold A, Brock-Utne JG 2011
• Laparoscopic diaphragmatic pacer placement - a potential new treatment for ALS patients: a brief description of the device and anesthetic issues JOURNAL OF CLINICAL ANESTHESIA Schmiesing, C. A., Lee, J., Morton, J. M., Brock-Utne, J. G. 2010; 22 (7): 549-552

  Abstract

  The Diaphragm Pacing Stimulator (DPS) has been used to treat ventilatory insufficiency in quadriplegic patients. The FDA approved a trial using the DPS in patients with amyotrophic lateral sclerosis (ALS). Three patients with advanced ALS, who underwent laparoscopic diaphragmatic pacer placement, and their general anesthetic management, are presented.

  View details for DOI 10.1016/j.jclinane.2009.09.010

  View details for PubMedID 21056813

• Pressure-Rated Needleless Access Connectors Slow IV Flow Rate ANESTHESIA AND ANALGESIA Caballero, J. A., Rivera, F., Edwards, J., Brock-Utne, J. G. 2010; 111 (4): 1077-1078

  View details for DOI 10.1213/ANE.0b013e3181f0948c

  View details for Web of Science ID 000282310200047

  View details for PubMedID 20870989

• "Where Are My Teeth?" A Case of Unnoticed Ingestion of a Dislodged Fixed Partial Denture ANESTHESIA AND ANALGESIA Lau, G., Kulkarni, V., Roberts, G. K., Brock-Utne, J. 2009; 109 (3): 836-838

  Abstract

  What are the dangers of swallowing foreign bodies of dental origin? How do we recognize when a patient has actually swallowed a dental appliance? How far should we pursue the retrieval of the appliance? We report a case of a patient with unnoticed ingestion of a dislodged fixed partial denture while undergoing general anesthesia and review the literature on dangers of swallowing foreign bodies of dental origin. Anesthesiologists should understand the dangers and recognize this complication when it happens, so that appropriate treatment can be pursued if necessary.

  View details for DOI 10.1213/ane.0b013e3181ae06c9

  View details for PubMedID 19690255

• A POOR CORRELATION EXISTS BETWEEN OSCILLOMETRIC AND RADIAL ARTERIAL BLOOD PRESSURE AS MEASURED BY THE PHILIPS MP90 MONITOR JOURNAL OF CLINICAL MONITORING AND COMPUTING Mireles, S. A., Jaffe, R. A., Drover, D. R., Brock-Utne, J. G. 2009; 23 (3): 169-174

  Abstract

  In anesthesia and critical care, invasive arterial blood pressure monitoring is the gold standard against which other methods of monitoring are compared. In this assessment of the Philips MP90 monitor, the objective was to determine whether or not oscillometric measurements were within the accuracy standards set by the Association for the Advancement of Medical Instrumentation (AAMI) and the British Hypertension Society (BHS). Three hundred and one invasive and noninvasive paired measurements were obtained from eleven adult patients on the neurosurgical service at Stanford University Medical Center. Bland-Altman plots were created to assess agreement between the two measurement systems. Paired correlation analysis, bias and precision calculations were performed. Oscillometric blood pressure measurements correlated with arterial measurements yielding Pearson r values of 0.68, 0.67 and 0.62 for systolic, diastolic and mean pressures, respectively (P < 0.01.) Mean differences with 95% confidence intervals were -3.8 mmHg +/- 13.6, -2.4 mmHg +/- 10.0, and 4.0 mmHg +/- 13.1 for systolic, diastolic and mean pressures, respectively. The mean difference for these measurements was

  View details for DOI 10.1007/s10877-009-9178-8

  View details for PubMedID 19396553

• An adjuvant of the cuff leak test ANAESTHESIA Eng, M. R., Wu, T. T., Brock-Utne, J. G. 2009; 64 (4): 452

  View details for DOI 10.1111/j.1365-2044.2009.05906_1.x

  View details for Web of Science ID 000264183800027

  View details for PubMedID 19317723

• Airway Obstruction in a Prone Patient ANESTHESIOLOGY Brock-Utne, J. G. 2009; 110 (3): 686-686

  View details for Web of Science ID 000263734900034

  View details for PubMedID 19237878

• Prevention of Corneal Abrasions in Patients with Autoimmune Dry Eyes ANESTHESIA AND ANALGESIA Zheng, K., Guta, C. G., Kulkarni, V., Brock-Utne, J. 2009; 108 (1): 385-386

  View details for DOI 10.1213/ane.0b013e31818c8fd7

  View details for Web of Science ID 000261963000072

  View details for PubMedID 19095888

• Is it more difficult to cannulate the right internal jugular vein in morbidly obese patients than in nonobese patients? OBESITY SURGERY Fujiki, M., Guta, C. G., Lemmens, H. J., Brock-Utne, J. G. 2008; 18 (9): 1157-1159

  Abstract

  The placement of an internal jugular vein (IJV) catheter is considered to be more difficult in morbidly obese patients. The objective of this study was to compare the success of simulated IJV puncture between morbidly obese patients and a nonobese control group.Thirty-four morbidly obese patients with body mass index (BMI, kg/m(2)) >/=40 were compared with 36 patients with BMI < 30. Right IJV puncture was simulated using an ultrasound probe directed towards the sternal notch at the midpoint between the sternal notch and the mastoid process. The investigator placing the probe was blinded as to the image being created on the ultrasound machine. Success rate was assessed at three different head rotation angles from midline; 0 degrees , 30 degrees , and 60 degrees .There was no statistically significant difference in successful simulated IJV puncture between two groups for any of the head positions. However, there was a higher incidence of the carotid artery (CA) puncture in the morbidly obese patient group when the head rotation was advanced from neutral position to 60 degrees (p < 0.05). In addition, the ultrasound showed significantly more overlapping of the IJV over the CA in morbidly obese patients at 0 degrees (p < 0.05) and 30 degrees (p < 0.05). Our results show no statistically significant difference in success rate of IJV puncture between morbidly obese patients and nonobese patients. Keeping the head in a neutral position in morbidly obese patients minimizes the overlapping of the IJV over the CA and the risk of CA puncture.However, due to the fact that even in the neutral position there is a significant increase in overlap between IJV and CA, we recommend the use of ultrasound guidance for IJV cannulation in obese patients.

  View details for DOI 10.1007/s11695-008-9590-z

  View details for Web of Science ID 000258456400020

  View details for PubMedID 18574645

• Does a delay in performing an activated clotting (ACT) test really matter? A study in nonheparinized blood and a single ACT machine. The Journal of extra-corporeal technology Philip, B. M., Brock-Utne, J. G., Lemmens, H. J., Jaffe, R. A., Shuttleworth, P. E. 2008; 40 (3): 193-195

  Abstract

  Activating clotting time (ACT) is a point-of-care, blood clotting test used to monitor anticoagulation. Recently, institutional requirements have required that ACT testing be completed outside the operating room with trained, certified personnel other than anesthesia staff. For this reason, in this study, we looked at whether a delay in processing an ACT makes a significant difference to the ACT results. Twenty patients between 18 and 65 years of age consented to the study, each undergoing non-cardiac surgery, with no intraoperative administration of heparin. The study was approved by our Institutional Review Board. A blood sample was taken from the patient's arterial line in the operating room. Immediately afterward, 1 mL was placed into each of two ACT cartridges and the measurement was done in a Medtronic ACT2 machine. The first ACT value was 126.9 +/- 14.5 seconds. The ACT value at approximately 30 minutes was 108.3 +/- 20.3 seconds (p < .0001). The time between the first and last measurements was 29.4 +/- 3.0 minutes. The results suggest that the ACT values decrease over time between sampling all measurements. At approximately 30 minutes, the ACT values average 15% less than the control measurements. Therefore, it would seem prudent to determine ACT values immediately in the operating room without any delay, using point-of-care testing.

  View details for PubMedID 18853832

• The dromedary sign - An unusual capnograph tracing ANESTHESIOLOGY Jaffe, R. A., Talavera, J. A., Hah, J. M., Brock-Utne, J. G. 2008; 109 (1): 149-150

  View details for Web of Science ID 000257135300022

  View details for PubMedID 18580185

• The reuse of anesthesia breathing systems: another difference of opinion and practice between the United States and Europe JOURNAL OF CLINICAL ANESTHESIA Halbeis, C. B., Macario, A., Brock-Ume, J. G. 2008; 20 (2): 81-83

  View details for DOI 10.1016/j.jclinane.2007.10.006

  View details for Web of Science ID 000255252000001

  View details for PubMedID 18410859

• The effects of esmolol and labetalol on cerebral blood flow velocity during electroconvulsive therapy EUROPEAN JOURNAL OF ANAESTHESIOLOGY van der Starre, P. J., Lemmens, H. J., Chandel, A., Brock-Utne, J. G., Solvason, H. B. 2008; 25 (2): 174-176

  View details for DOI 10.1017/S0265021507002529

  View details for Web of Science ID 000253140300017

  View details for PubMedID 18251042

• The effect of deliberate hypercapnia and hypocapnia on mtraoperative blood loss and quality of surgical field during functional endoscopic sinus surgery ANESTHESIA AND ANALGESIA Nekhendzy, V., Lemmens, H. J., Vaughan, W. C., Hepworth, E. J., Chiu, A. G., Church, C. A., Brock-Utne, J. G. 2007; 105 (5): 1404-1409

  Abstract

  Anesthetic management during functional endoscopic sinus surgery is aimed at minimizing bleeding and establishing a near-perfect surgical field. We investigated whether deliberate intraoperative hypercapnia and hypocapnia may affect blood loss and quality of surgical field through a proposed modulating effect of different carbon dioxide (CO2) tension levels on nasal vasculature.One hundred and eighty patients were randomly assigned to normocapnia (end-tidal CO2 [ETco2] 37 +/- 2 mm Hg), hypercapnia (ETco2 60 +/- 2 mm Hg), and hypocapnia (ETco2 27 +/- 2 mm Hg) groups. Anesthetic management was with propofol and remifentanil infusions, nitrous oxide, and moderate controlled hypotension. Blood loss and operating conditions were assessed by the surgeon who was blinded to group assignment. Differences among the study groups, the effect of the study group and time on ETco2 levels and hemodynamic variables, and the association of blood loss with surgical covariates were analyzed.There were no differences in blood loss and quality of surgical field among the study groups. Patients in the hypocapnia group demonstrated the highest, and in the hypercapnia group, the lowest, requirements for remifentanil, labetalol, and administration of the antihypertensive medications in general. The computed tomography-graded severity of sinonasal disease and duration of surgery were the only independent predictors of intraoperative blood loss.CO2 management during functional endoscopic sinus surgery does not influence operating conditions or blood loss.

  View details for DOI 10.1213/01.ane.0000282781.56025.52

  View details for Web of Science ID 000250317500037

  View details for PubMedID 17959973

• New methods for direct verification of correct endotracheal tube placement ANESTHESIA AND ANALGESIA Angelotti, T., Brock-Utne, J. 2007; 105 (4): 1168-1168

  View details for DOI 10.1213/01.ane.0000278153.05254.48

  View details for Web of Science ID 000249678500047

  View details for PubMedID 17898410

• Be aware of the patient with an eye patch ANESTHESIA AND ANALGESIA Brock-Utne, J. G. 2007; 104 (6): 1615

  View details for DOI 10.1213/01.ane.0000260549.38674.15

  View details for Web of Science ID 000246791000084

  View details for PubMedID 17513683

• Drug delivery via the tracheal tube using an airway device. A warning PEDIATRIC ANESTHESIA Bernstein, O., Eide, A., Brock-Utne, J. G. 2007; 17 (6): 604

  View details for DOI 10.1111/j.1460-9592.2006.02183.x

  View details for Web of Science ID 000246317900026

  View details for PubMedID 17498036

• More cockroaches ANESTHESIA AND ANALGESIA Brock-Utne, J. G. 2006; 103 (6): 1604–5

  View details for DOI 10.1213/01.ane.0000246279.61915.cc

  View details for Web of Science ID 000242289100085

  View details for PubMedID 17122269

• Securing the airway of a 'super sized' patient: another use for the Aintree Catheter (R) EUROPEAN JOURNAL OF ANAESTHESIOLOGY Schmiesing, C., Collins, J., Ottestad, E., Kulkarni, V., Brock-Utne, J. 2006; 23 (12): 1064-1066

  View details for Web of Science ID 000242303600016

  View details for PubMedID 17042968

• Esophageal saturation during antegrade cerebral perfusion: a preliminary report using visible light spectroscopy PEDIATRIC ANESTHESIA Heninger, C., Ramamoorthy, C., Amir, G., Kamra, K., Reddy, V. M., Hanley, F. L., Brock-Utne, J. G. 2006; 16 (11): 1133-1137

  Abstract

  Visible light spectroscopy (VLS) is newer technology that measures real-time tissue oxygenation. It has been validated in detecting mucosal ischemia in adults. During complex neonatal heart surgery, antegrade cerebral perfusion (ACP) maintains cerebral saturation. Whether ACP maintains peripheral tissue perfusion in humans is not known.Five patients undergoing neonatal open heart surgery with hypothermic cardiopulmonary bypass (CPB) were studied using a VLS esophageal probe in addition to bilateral near infrared cerebral oximetry. Three of five patients required ACP for arch repair, while two patients did not. VLS and cerebral saturation data were collected and analyzed in 5 min intervals prior to CPB, during CPB, and during ACP.In the two patients undergoing heart surgery with routine hypothermic CPB, both cerebral and esophageal saturations were maintained. However in all three neonates requiring ACP, although cerebral saturations did not decrease, esophageal saturation fell below the ischemic threshold (35%). Following establishment of normal CPB, esophageal saturation returned to baseline.Antegrade cerebral perfusion maintains cerebral oxygen delivery, however, it does not adequately perfuse the esophagus in neonates. This could have clinical implications.

  View details for DOI 10.1111/j.1460-9592.2006.01965.x

  View details for Web of Science ID 000241245400004

  View details for PubMedID 17040301

• Failure to recognize tension pneumoperitoneum during resuscitation ANAESTHESIA AND INTENSIVE CARE Ternlund, S. P., Brock-Utne, J. G. 2006; 34 (4): 517–18

  View details for Web of Science ID 000240569100027

  View details for PubMedID 16917997

• Intra-operative fluid volume influences postoperative nausea and vomiting after laparoscopic gastric bypass surgery OBESITY SURGERY Schuster, R., Alami, R. S., Curet, M. J., Paulraj, N., Morton, J. M., Brodsky, J. B., Brock-Utne, J. G., Lemmens, H. J. 2006; 16 (7): 848-851

  Abstract

  Laparoscopic Roux-en-Y gastric bypass (RYGBP) is a commonly performed operation for morbid obesity. A significant number of patients experience postoperative nausea and vomiting (PONV) following this procedure. The aim of this study was to determine the effect, if any, of intra-operative fluid replacement on PONV.Patients who underwent laparoscopic (RYGBP) for morbid obesity during a 12-month period were included in this retrospective analysis. Demographic data including age, gender, and body mass index (BMI) were collected. Perioperative data also included total volume of intra-operative fluids administered, rate of administration, urine output, length of surgery, and incidence of PONV as determined by nursing or anesthesia records in the postanesthesia care unit (PACU). Data were analyzed by t-test.The table below depicts demographic and perioperative data, comparing patients who experienced PONV (n=125) in the PACU with those who did not (n=55). Values are mean +/- standard deviation.PONV is a common complication after laparoscopic RYGB. Patient who did not experience PONV received a larger volume of intravenous fluid at a faster rate than similar patients who complained of PONV.

  View details for Web of Science ID 000239131000007

  View details for PubMedID 16839481

• General anesthesia and chronic amphetamine use: Should the drug be stopped preoperatively? ANESTHESIA AND ANALGESIA Fischer, S. P., Schmiesing, C. A., Guta, C. G., Brock-Utne, J. G. 2006; 103 (1): 203-206

  Abstract

  Prescription amphetamines are being used more often for several medical conditions. Anesthesia concerns focus on the cardiovascular stability of patients who may be catecholamine-depleted and thus have a blunted response to intraoperative hypotension. Previously we reported one case of a patient receiving chronic amphetamine therapy who had a stable intraoperative course. We now report eight additional patients taking chronic prescription amphetamines who underwent a safe general anesthesia and outcome. Predominantly prescribed for narcolepsy and attention deficit hyperactivity disorder, amphetamine drugs had been given to these 8 patients for 2 to 10 yr. Ages ranged from 22 to 77 yr and genders were equally divided. All required general anesthesia for their surgical procedures and 6 of the 8 patients were tracheally intubated. Anesthesia operating room times ranged from 30 min to 4.25 h. The authors conclude that amphetamine use need not be stopped before surgery and anesthesia.

  View details for DOI 10.1213/01.ane.0000221451.24482.11

  View details for Web of Science ID 000238661900040

  View details for PubMedID 16790654

• The haemodilution enhanced onset of coagulation as measured by the thrombelastogram is transient EUROPEAN JOURNAL OF ANAESTHESIOLOGY Ruttmann, T. G., Lemmens, H. J., Malott, K. A., Brock-Utne, J. G. 2006; 23 (7): 574-579

  Abstract

  Crystalloid haemodilution has been widely found to enhance coagulation onset, but the duration of this effect has never been documented.Twelve healthy, consenting volunteers had a rapid infusion of 14 mL kg-1 of normal (0.9%) saline. Blood samples were taken, prior to (control), and immediately after (30 min) the rapid saline infusion was completed (30 min). They were then repeated at regular intervals up to 120 min. Haematocrit/platelet counts were taken to determine the degree of dilution and thrombelastograms, with and without platelet antagonists (ReoPro, Abciximab), were measured in all samples. Antithrombin levels were selectively measured.The haematocrit and platelet count showed a rapid dilutional decrease at 30 min (mean of -12.2% and -14.4%, respectively), with values returning towards baseline within 15 min after finishing the infusion. There was a significantly faster onset of coagulation (decrease in r-time) in the post-infusion sample (30 min) compared to control (P<0.05), again returning towards normal as the dilution effect was reversed. Similar thrombelastograms findings were evident in the plasma factor only group (platelets inhibited by ReoPro). Antithrombin levels changed in keeping with the haemodilution effect (P<0.0001). There was a linear relationship between antithrombin and thrombelastograms r-time (P=0.012).The faster onset of coagulation brought on by haemodilution return towards normal as the dilutional effect is reversed. This effect is mediated through plasma clotting factors. Of interest is the significant inverse correlation of the onset of coagulation increasing as the antithrombin levels decreased with dilution.

  View details for DOI 10.1017/S0265021506000238

  View details for Web of Science ID 000238752100006

  View details for PubMedID 16507197

• Fiberoptic light source-induced surgical fires - the contribution of forced-air warming blankets ACTA ANAESTHESIOLOGICA SCANDINAVICA Williams, D. M., Littwin, S., Patterson, A. J., Brock-Utne, J. G. 2006; 50 (4): 505-508

  Abstract

  Fiberoptic light sources have been identified as a fire ignition mechanism in the operating room. This study attempted to determine whether a forced-air warming blanket (FAWB) could affect the ignition or spread of fire caused by a fiberoptic light source.We exposed surgical drapes to a fiberoptic light source at close range. The results were categorized according to time to first smoke and damage resulting at 1 min. Data were analyzed using the Mann-Whitney rank-sum test.The sums of the rank values for the components of the drape indicated that there was a greater than 96.8-99.2% chance that the FAWB accelerated the time to first smoke. The FAWB appeared to protect the patient gown from damage during all trials. The presence of an FAWB under a surgical drape accelerated the time to first smoke when exposed to unprotected fiberoptic light sources, yet prevented damage to the underlying patient gown. In an actual surgical setting, it is likely that the FAWB would offer some protection to the patient's skin directly below the surgical drape.It is likely that the FAWB can offer some protection to the patient should an unprotected fiberoptic light source cause a fire.

  View details for DOI 10.1111/j.1399-6576.2006.00975.x

  View details for Web of Science ID 000236069900015

  View details for PubMedID 16548865

• Central venous access in obese patients: A potential complication ANESTHESIA AND ANALGESIA Ottestad, E., Schmiessing, C., Brock-Utne, J. G., Kulkarni, V., Parris, D., Brodsky, J. B. 2006; 102 (4): 1293-1294

  View details for Web of Science ID 000236371100072

  View details for PubMedID 16551951

• Verification of endotracheal tube placement by prehospital providers: is a portable fiberoptic bronchoscope of value? Air medical journal Angelotti, T., Weiss, E. L., Lemmens, H. J., Brock-Utne, J. 2006; 25 (2): 74-78

  Abstract

  This study was designed to examine whether a handheld, battery-operated fiberoptic bronchoscope (FOB) used to verify endotracheal tube (ETT) placement would be as sensitive and specific as other modes and whether a combination of multiple modes would further enhance the sensitivity and specificity of ETT placement verification.An academic hospital-based air medical program.This was a prospective, randomized study examining surgical patients undergoing general endotracheal anesthesia. Eighteen critical care transport (CCT) nurses, previously unfamiliar with FOB, were asked to identify intratracheal and intraesophageal ETTs by using misting, end-tidal carbon dioxide concentration (ETCO(2)), and FOB alone or with a combination of all three modes. The sensitivity and specificity of single and multimode verification were calculated and compared.Comparison of ETT verification by single mode alone revealed a rank order of sensitivity with ETCO(2) (0.97) > FOB (0.87) > misting (0.84), whereas all three modes had similar specificities (0.93-0.94). However, the use of the three-mode combination revealed a sensitivity and specificity of 1.0.As a single mode for ETT verification, use of a handheld, battery-operated FOB device allowed for direct visualization and had an 87% sensitivity and 93% specificity. When combined with misting and ETCO(2), FOB allowed 100% successful verification of ETT placement.

  View details for PubMedID 16516118

• Hasty C-arm positioning: A recipe for disaster ANESTHESIA AND ANALGESIA Brock-Utne, J. G., Bolton, P., Zisook, G. M. 2006; 102 (2): 644

  View details for DOI 10.1213/01.ANE.0000190736.77531.EC

  View details for Web of Science ID 000234912900062

  View details for PubMedID 16428579

• Minimizing the incidence of heparin-induced thrombocytopenia: to heparinize or not to heparinize vascular access? PEDIATRIC ANESTHESIA Chow, J. L., Brock-Utne, J. G. 2005; 15 (12): 1037-1040

  View details for DOI 10.1111/j.1460-9592.2005.01755.x

  View details for Web of Science ID 000234051000001

  View details for PubMedID 16324020

• A simple method to identify an external vaporizer leak (the "SNIFF" method) ANESTHESIA AND ANALGESIA Bolton, P., Brock-Utne, J. G., Zumaran, A. A., Cummings, J., Armstrong, D. 2005; 101 (2): 606-607

  View details for Web of Science ID 000230739100055

  View details for PubMedID 16037185

• Artifactual increase in the arterial pressure waveform: Remember the stopcock ANESTHESIA AND ANALGESIA Eggen, M. A., Brock-Utne, J. G. 2005; 101 (1): 298-299

  View details for DOI 10.1213/01.ANE.0000156701.18472.05

  View details for Web of Science ID 000229888000062

  View details for PubMedID 15976256

• Nitrous oxide and laparoscopic bariatric surgery OBESITY SURGERY Brodsky, J. B., Lemmens, H. J., Collins, J. S., Morton, J. M., Curet, M. J., Brock-Utne, J. G. 2005; 15 (4): 494-496

  Abstract

  Nitrous oxide (N2O) is frequently used to supplement more potent anesthetic agents. One side-effect of N2O is its ability to expand an air-containing space. We investigated if N2O adversely affected operating conditions by distending normal bowel during laparoscopic bariatric procedures.50 morbidly obese patients were divided into 2 study groups. Group 1 patients were ventilated with a halogenated anesthetic/oxygen/air mixture, while Group 2 received a halogenated anesthetic/oxygen/N2O mixture. At 30, 60, and 90 min intervals during the operation, the surgeon was asked if N2O was being used.The surgeons responded correctly only 42% (30 min), 50% (60 min), and 48% (90 min) of the time. In Group 2 (N2O) patients, they incorrectly answered that N2O was not being used 88% (30 min), 68% (60 min), and 68% (90 min); and in Group 1 (air) patients, they incorrectly answered that N2O was being used 28% (30 min), 32% (60 min), and 36% (90 min) of the time.We found that using N2O did not cause noticeable bowel distention during laparoscopic bariatric procedures of relatively short duration.

  View details for Web of Science ID 000228911000006

  View details for PubMedID 15946427

• Gastric volume and pulmonary aspiration EUROPEAN JOURNAL OF ANAESTHESIOLOGY Brock-Utne, J. G. 2005; 22 (4): 321-321

  View details for Web of Science ID 000229535600019

  View details for PubMedID 15892418

• The demise of general anesthesia in obstetrics revisited: prescription for a cure INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA Lipman, S., Carvalho, B., Brock-Utne, J. 2005; 14 (1): 2-4

  View details for DOI 10.1016/j.ijoa.2004.10.003

  View details for Web of Science ID 000226572000002

  View details for PubMedID 15627530

• Anesthetic concerns for robot-assisted laparoscopy in an infant ANESTHESIA AND ANALGESIA Mariano, E. R., Furukawa, L., Woo, R. K., Albanese, C. T., Brock-Utne, J. G. 2004; 99 (6): 1665-1667

  Abstract

  A 2-mo-old infant with biliary atresia was scheduled for laparoscopic Kasai with robot assistance. Before surgery, a practice trial maneuvering the cumbersome robotic equipment was performed to ensure rapid access to the patient in case of emergency. IV access, tracheal intubation, and arterial line placement followed inhaled anesthesia induction with sevoflurane. Robotic setup took 53 min and severely limited patient access. No adverse events occurred during the procedure requiring the removal of the robotic equipment, and the patient was discharged after a stable postoperative recovery. Advance preparation is required to maximize patient safety during robotic surgery.

  View details for DOI 10.1213/01.ANE.0000137394.99683.66

  View details for Web of Science ID 000225341600016

  View details for PubMedID 15562050

• Laryngoscopy and morbid obesity: a comparison of the "sniff" and "ramped" positions OBESITY SURGERY Collins, J. S., Lemmens, H. J., Brodsky, J. B., Brock-Utne, J. G., Levitan, R. M. 2004; 14 (9): 1171-1175

  Abstract

  The effect of patient position on the view obtained during laryngoscopy was investigated.60 morbidly obese patients undergoing elective bariatric were studied. Patients were randomly assigned into one of two groups. In Group 1, a conventional "sniff" position was obtained by placing a firm 7-cm cushion underneath the patient's head, thus raising the occiput a standard distance from the operating-table while the patient remained supine. In Group 2, a "ramped" position was achieved by arranging blankets underneath the patient's upper body and head until horizontal alignment was achieved between the external auditory meatus and the sternal notch. Following induction of general anesthesia, tracheal intubation was performed using a Video MacIntosh laryngoscope. The laryngoscopy and intubation sequences were recorded onto videotape. Three independent investigators, unaware as to which position the patient had been in at the time of tracheal intubation, then viewed the videotape and assigned a numerical grade to the best laryngeal view obtained.The "ramped" position improved the laryngeal view when compared to a standard "sniff" position, and this difference was statistically significant (P=0.037).The "ramped" position is superior to the standard "sniff" position for direct laryngoscopy in morbidly obese patients.

  View details for PubMedID 15527629

• Management of acute complete tracheal transection caused by nonpenetrating trauma: Report of a case and review of the literature JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Chow, J. L., Coady, M. A., Varner, J., Cannon, W., Spain, D., Brock-Utne, J. G. 2004; 18 (4): 475-478

  View details for DOI 10.1053/j.jvca.2004.05.007

  View details for Web of Science ID 000224223500017

  View details for PubMedID 15365933

• Latex allergy: Oh, what a surprise! Another reason why all anesthesia equipment should be latex-free ANESTHESIA AND ANALGESIA Eckinger, P., Ratner, E., Brock-Utne, J. 2004; 99 (2): 629-629

  View details for DOI 10.1213/01.ANE.0000131457.38817.82

  View details for Web of Science ID 000222897100073

  View details for PubMedID 15271766

• Continuous, noninvasive, and localized microvascular tissue oximetry using visible light spectroscopy ANESTHESIOLOGY Benaron, D. A., Parachikov, I. H., Friedland, S., Soetikno, R., Brock-Utne, J., van der Starre, P. J., Nezhat, C., Terris, M. K., Maxim, P. G., Carson, J. J., Razavi, M. K., Gladstone, H. B., Fincher, E. F., Hsu, C. P., Clark, F. L., Cheong, W. F., Duckworth, J. L., Stevenson, D. K. 2004; 100 (6): 1469-1475

  Abstract

  The authors evaluated the ability of visible light spectroscopy (VLS) oximetry to detect hypoxemia and ischemia in human and animal subjects. Unlike near-infrared spectroscopy or pulse oximetry (SpO2), VLS tissue oximetry uses shallow-penetrating visible light to measure microvascular hemoglobin oxygen saturation (StO2) in small, thin tissue volumes.In pigs, StO2 was measured in muscle and enteric mucosa during normoxia, hypoxemia (SpO2 = 40-96%), and ischemia (occlusion, arrest). In patients, StO2 was measured in skin, muscle, and oral/enteric mucosa during normoxia, hypoxemia (SpO2 = 60-99%), and ischemia (occlusion, compression, ventricular fibrillation).In pigs, normoxic StO2 was 71 +/- 4% (mean +/- SD), without differences between sites, and decreased during hypoxemia (muscle, 11 +/- 6%; P < 0.001) and ischemia (colon, 31 +/- 11%; P < 0.001). In patients, mean normoxic StO2 ranged from 68 to 77% at different sites (733 measures, 111 subjects); for each noninvasive site except skin, variance between subjects was low (e.g., colon, 69% +/- 4%, 40 subjects; buccal, 77% +/- 3%, 21 subjects). During hypoxemia, StO2 correlated with SpO2 (animals, r2 = 0.98; humans, r2 = 0.87). During ischemia, StO2 initially decreased at -1.3 +/- 0.2%/s and decreased to zero in 3-9 min (r2 = 0.94). Ischemia was distinguished from normoxia and hypoxemia by a widened pulse/VLS saturation difference (Delta < 30% during normoxia or hypoxemia vs. Delta > 35% during ischemia).VLS oximetry provides a continuous, noninvasive, and localized measurement of the StO2, sensitive to hypoxemia, regional, and global ischemia. The reproducible and narrow StO2 normal range for oral/enteric mucosa supports use of this site as an accessible and reliable reference point for the VLS monitoring of systemic flow.

  View details for Web of Science ID 000221551300018

  View details for PubMedID 15166566

• Incidence of airway compromise in morbidly obese patients recovering from general anesthesia after laparoscopic gastric bypass surgery Brock-Utne, J. G., Chow, J. L., Williams, D. M., Lemens, H. J., Feasters, W. LIPPINCOTT WILLIAMS & WILKINS. 2004: 68

  View details for DOI 10.1097/00003643-200406002-00247

  View details for Web of Science ID 000459215900248

• Incidence of airway compromise in cardiac patients undergoing conscious sedation for implantable cardioverter defibrillator placement Chow, J. L., Hanowell, J. H., Williams, D. M., Lemmens, H. J., Chun, S., Brock-Utne, J. G. LIPPINCOTT WILLIAMS & WILKINS. 2004: 65–66

  View details for DOI 10.1097/00003643-200406002-00237

  View details for Web of Science ID 000459215900238

• Wrist hyperextension leads to median nerve conduction block - Implications for intra-arterial catheter placement ANESTHESIOLOGY Chowet, A. L., Lopez, J. R., Brock-Utne, J. G., Jaffe, R. A. 2004; 100 (2): 287-291

  Abstract

  It is common practice to hyperextend the wrist to facilitate insertion of a radial intra-arterial catheter. This position may be maintained for prolonged periods. Although there has been much discussion about optimal patient management to protect the ulnar nerve and brachial plexus, little attention has been paid to the median nerve during wrist hyperextension. The authors report the effects of wrist hyperextension on conduction in the median nerve.Median nerve conduction was studied in 12 awake, healthy volunteers using standard nerve conduction tests consisting of the measurement of compound sensory and motor action potentials, as well as their amplitudes and latencies. With the contralateral hand as a control, the right wrist was placed in hyperextension (angled between 65 and 80 degrees), and compound action potentials were recorded to determine the onset and magnitude of effects. Subsequently, the hand was released from hyperextension and recovery was recorded.In 83% of subjects, hyperextension resulted in a significant decrease in compound sensory action potential amplitudes, sufficient to qualify as conduction block (16.6% of baseline). The average time to conduction block was 43 +/- 13.2 min. All subjects who manifested conduction block showed marked improvement 5 min after release from hyperextension.Wrist hyperextension for arterial line placement and stabilization is likely to result in profound impairment of median nerve function. Although the effects were transient in this study, the results suggest that prolonged hyperextension may be associated with significant changes in median nerve conduction. To minimize the chance for nerve injury, the authors recommend that wrists be returned promptly to the neutral position following arterial line placement.

  View details for Web of Science ID 000188438500015

  View details for PubMedID 14739802

• Heat and moisture exchange devices: Are they doing what they are supposed to do? ANESTHESIA AND ANALGESIA Lemmens, H. J., Brock-Utne, J. G. 2004; 98 (2): 382-385

  Abstract

  Heat and moisture exchangers (HMEs) are used to provide humidification and warming of the inspiratory gases during general anesthesia. The performance specifications provided by manufacturers of HMEs are based on in vitro measurements of moisture output using the International Standards Organization (ISO) 9360 method. We studied the in vivo performance of three different HMEs with similar ISO specifications in a randomized crossover fashion in patients under general anesthesia. The effect of each HME on temperature, convective heat loss, evaporative heat loss, total heat loss, relative humidity, and absolute humidity of inspiratory gases was determined. Although all HMEs in general improved baseline variables, we found significant differences in performance for the different HMEs. In only one type did the moisture output correspond with ISO specifications. We conclude that the in vivo performance of HMEs may not correspond with manufacturer's specifications.There is considerable variability in the in vivo performance of heat and moisture exchangers that have similar manufacturer specifications. These specifications, based on the International Standards Organization 9360 standard, which is measured in vitro, cannot be used to predict clinical performance.

  View details for DOI 10.1213/01.ANE.0000096560.96727.37

  View details for Web of Science ID 000188438700021

  View details for PubMedID 14742374

• Clinical manifestations of latex anaphylaxis during anesthesia differ from those not anesthesia/surgery-related ANESTHESIA AND ANALGESIA Brock-Utne, J. G. 2003; 97 (4): 1204-1204

  View details for DOI 10.1213/01.ANE.0000077648.77618.74

  View details for Web of Science ID 000185492300069

  View details for PubMedID 14500193

• Seizure duration with remifentanil/methohexital vs. methohexital alone in middle-aged patients undergoing electroconvulsive therapy ACTA ANAESTHESIOLOGICA SCANDINAVICA Smith, D. L., Angst, M. S., Brock-Utne, J. G., Debattista, C. 2003; 47 (9): 1064-1066

  Abstract

  The object of this study was to test whether substituting part of the methohexital dose with the short-acting opioid remifentanil would prolong seizure duration in middle-aged patients while providing a similar depth of anesthesia as with methohexital alone. This has been reported for the combined use of methohexital and remifentanil in elderly patients, but has not been investigated in middle-aged patients likely to require a higher total dose of methohexital for inducing anesthesia.Seven patients (42+/-10 years; mean +/-SD) receiving electroconvulsive therapy (ECT) were anesthetized with methohexital (1.25 mg kg-1) or with methohexital (0.625 mg kg-1) plus remifentanil (1 micro g kg-1) in this randomized, double blind, crossover study. Additional methohexital was given as needed until loss of eyelash reflex was observed. Suxamethonium (1 mg kg-1) was used for muscular paralysis.Motor and EEG seizure durations were significantly longer after induction with methohexital plus remifentanil (45+/-14 and 58+/-15 s) than with methohexital alone (31+/-11 and 42+/-18 s). A methohexital dose of 1.2+/-0.3 and 1.9+/-0.3 mg was necessary to achieve loss of eyelash reflex if methohexital was used with and without remifentanil. Peak heart rate after ECT was significantly higher if remifentanil was coadministered with methohexital (148+/-12 vs. 126+/-24 b.p.m).Substituting part of the methohexital dose with remifentanil is a useful anesthetic technique to prolong seizure duration in middle-aged patients requiring a 1.5-fold higher induction dose of methohexital than elderly patients, the only population studied to date for the combined use of methohexital and remifentanil in ECT.

  View details for PubMedID 12969096

• Immediate control of life-threatening digoxin intoxication in a child by use of digoxin-specific antibody fragments (Fab) PAEDIATRIC ANAESTHESIA Husby, P., Farstad, M., Brock-Utne, J. G., Koller, M. E., Segadal, L., Lund, T., Ohm, O. J. 2003; 13 (6): 541-546

  Abstract

  Digoxin-immune antibody fragments (Fab) for treatment of digitalis intoxication was introduced in 1976. Many reports have been published concerning this therapy for children, but few have focused on its immediate reversal of cardiac as well as extracardiac life-threatening manifestations of digoxin toxicity. We present a case of life-threatening digitalis intoxication in a child with postoperative renal insufficiency, after a Sennings procedure for transposition of the great arteries. Digoxin administration according to the nationally recommended dosage and intervals unexpectedly resulted in serum levels in the toxic range. Severe cardiac arrhythmias, haemodynamic instability and a rapid-increasing serum potassium level resulted. This report demonstrates how administration of Fab according to the manufacturer's dosage recommendation reversed the tachyarrhythmia immediately and re-established a normal level of serum potassium within minutes.

  View details for Web of Science ID 000183963800013

  View details for PubMedID 12846714

• Anesthetic considerations for bariatric surgery: Proper positioning is important for laryngoscopy ANESTHESIA AND ANALGESIA Brodsky, J. B., Lemmens, H. J., Brock-Utne, J. G., Saidman, L. J. 2003; 96 (6): 1841-1842

  View details for DOI 10.1213/01.ANE.0000063165.15467.1B

  View details for Web of Science ID 000183148900060

  View details for PubMedID 12761028

• The timing of electroconvulsive therapy and bispectral index after anesthesia induction using different drugs does not affect seizure duration JOURNAL OF CLINICAL ANESTHESIA Lemmens, H. J., Levi, D. C., Debattista, C., Brock-Utne, J. G. 2003; 15 (1): 29-32

  Abstract

  To determine the association between bispectral index (BIS) and seizure duration obtained by electroconvulsive therapy (ECT) administered sooner or later after anesthetic induction.Prospective, randomized, crossover study.University-affiliated medical center.Nine ASA physical status I, II, and III patients undergoing a total of 31 ECTs.ECT was administered soon (<210 sec) or later (between 210 sec and 360 sec) after anesthetic induction. In each individual patient, drug regimens and ECT machine settings were identical.BIS immediately before the start of the ECT and the duration of the EEG seizure were recorded, as well as the time period between loss of consciousness and ECT administration.There was no relationship between BIS level and seizure duration. Moreover, seizure duration was not dependent on the time of ECT administration in the time window between one and 6 minutes after loss of consciousness.The hypnotic drug effect measured by the BIS is not correlated to the seizure duration obtained by ECT.

  View details for DOI 10.1016/S0952-8180(02)00477-4

  View details for Web of Science ID 000182004300006

  View details for PubMedID 12657408

• Fetal heart rate decelerations during ECT-induced seizures: is it important? ACTA ANAESTHESIOLOGICA SCANDINAVICA Debattista, C., Cochran, M., Barry, J. J., Brock-Utne, J. G. 2003; 47 (1): 101-103

  Abstract

  Electroconvulsive therapy (ECT) is sometimes indicated during pregnancy and may offer advantages over pharmacotherapy for the patient and the fetus (1,2). However, very little data is available on the impact of epileptic or ECT-induced seizures on the fetus. We report a case of brief fetal heart rate decelerations in a fetus associated with maternal ECT-induced convulsions.

  View details for Web of Science ID 000179948400019

  View details for PubMedID 12492807

• A modification of the Yodfat Laryngeal Mask Airway insertion technique JOURNAL OF CLINICAL ANESTHESIA Jaffe, R. A., Brock-Utne, J. G. 2002; 14 (6): 462-463

  Abstract

  We present here a case of a common problem for the anesthesiologist, i.e., difficulty in placing a Laryngeal Mask Airway (LMA). One solution is the use of the Yodfat technique to facilitate placement of the LMA.

  View details for Web of Science ID 000178876300015

  View details for PubMedID 12393119

• Morbid obesity and tracheal intubation ANESTHESIA AND ANALGESIA Brodsky, J. B., Lemmens, H. J., Brock-Utne, J. G., Vierra, M., Saidman, L. J. 2002; 94 (3): 732-736

  Abstract

  The tracheas of obese patients may be more difficult to intubate than those of normal-weight patients. We studied 100 morbidly obese patients (body mass index >40 kg/m(2)) to identify which factors complicate direct laryngoscopy and tracheal intubation. Preoperative measurements (height, weight, neck circumference, width of mouth opening, sternomental distance, and thyromental distance) and Mallampati score were recorded. The view during direct laryngoscopy was graded, and the number of attempts at tracheal intubation was recorded. Neither absolute obesity nor body mass index was associated with intubation difficulties. Large neck circumference and high Mallampati score were the only predictors of potential intubation problems. Because in all but one patient the trachea was intubated successfully by direct laryngoscopy, the neck circumference that requires an intervention such as fiberoptic bronchoscopy to establish an airway remains unknown. We conclude that obesity alone is not predictive of tracheal intubation difficulties.In 100 morbidly obese patients, neither obesity nor body mass index predicted problems with tracheal intubation. However, a high Mallampati score (greater-than-or-equal to 3) and large neck circumference may increase the potential for difficult laryngoscopy and intubation.

  View details for Web of Science ID 000174031800047

  View details for PubMedID 11867407

• Airway complication following functional endoscopic sinus surgery JOURNAL OF CLINICAL ANESTHESIA Holden, J. P., Vaughan, W. C., Brock-Utne, J. G. 2002; 14 (2): 154-157

  Abstract

  Difficulty breathing after upper airway surgery requires immediate evaluation and treatment. We present a case of airway compromise after sinus surgery due to edema of the uvula. The patient was admitted for observation overnight and discharged the next day. A discussion of potential airway changes after sinonasal surgery is presented.

  View details for Web of Science ID 000175105100017

  View details for PubMedID 11943532

• Gastroesophageal reflux and aspiration of gastric contents ANESTHESIA AND ANALGESIA Brock-Utne, J. G. 2002; 94 (3): 762-762

  View details for Web of Science ID 000174031800053

  View details for PubMedID 11867413

• Oral midazolam with an antacid may increase the speed of onset of sedation in children prior to general anaesthesia Annual Meeting of the International-Society-of-Anaesthesia-Research Lammers, C. R., Rosner, J. L., Crockett, D. E., Chhokra, R., Brock-Utne, J. G. WILEY-BLACKWELL PUBLISHING, INC. 2002: 26–28

  Abstract

  The aim of the study was to see whether sodium citrate solution would speed the gastric absorption of oral midazolam.Forty presurgical ASA I and II patients (aged 2-6 years) were randomly assigned to one of two groups. Group I received midazolam 0.5 mg x kg(-1) mixed with sodium citrate while group II (control) received midazolam 0.5 mg x kg(-1) mixed with Hawaiian fruit punch.There was no statistical difference between the ages, weights, preoperative sedation and anxiety scores in the two groups. After premedication, the onset of sedation (mean +/- SD) measured by the first change in sedation score was found to be significantly faster (P < 0.05) in group I (17.8 +/- 7.11) compared with group II (21.9 +/- 5.34). There was no statistical difference in anxiety at any time intervals, separation or induction scoring for both groups. Gastric volumes and the pH of gastric aspirates between the two groups were not statistically significant.The time to onset of sedation can potentially be shortened, by using a preparation of intravenous midazolam and antacid, given orally.

  View details for Web of Science ID 000173651100003

  View details for PubMedID 11849571

• Is cricoid pressure necessary? PAEDIATRIC ANAESTHESIA Brock-Utne, J. G. 2002; 12 (1): 1-4

  View details for Web of Science ID 000173651100001

  View details for PubMedID 11849569

• Awake craniotomy ANAESTHESIA AND INTENSIVE CARE Brock-Utne, J. G. 2001; 29 (6): 669-669

  View details for Web of Science ID 000172734500020

  View details for PubMedID 11771615

• Suppression of cough during emergence from general anesthesia: Laryngotracheal lidocaine through a modified endotracheal tube JOURNAL OF CLINICAL ANESTHESIA Diachun, C. A., Tunink, B. P., Brock-Utne, J. G. 2001; 13 (6): 447-451

  Abstract

  To ascertain if coughing during emergence from general anesthesia can be suppressed with a modified endotracheal tube.Randomized, double-blind, controlled study.Operating rooms at a university hospital.46 adult ASA physical status I, II, and III patients requiring elective surgery.Patients underwent general anesthesia with the laryngotracheal instillation of topical anesthesia (LITA) endotracheal tube (ETT). Thirty minutes before anticipated extubation, one investigator administered, via the LITA tube injection port onto the laryngotracheal mucosa, one of the following according to randomized preselection: 2 mg/kg with 4% lidocaine (Group I; n = 15); 4 mL with saline (Group 2;n = 16); and nothing (Control; n = 15). At the completion of surgery, with the patient adequately anesthetized, the oropharynx was gently suctioned, and the isoflurane was then turned off. When the isoflurane end-tidal concentration was < or =0.2%, the neuromuscular block was reversed and the inspiratory oxygen concentration was increased to 100% while awaiting the return of spontaneous ventilation.An observer who was blinded to the study drug regimens judged the presence or absence of cough upon emergence, over a 1-minute period. The observer noted the responses to the following verbal commands, in this order: 1) "open your eyes", 2) "grip my hand", and 3) "lift your head". Coughing was defined as any evidence of irritation from having a tube in the trachea. Blood samples for plasma lidocaine levels were taken at the time of extubation from patients who received lidocaine (Group 1).Seventy-five percent of patients were found to have complete cough suppression upon emergence, while Group 2 (saline) had 14% and Group 3 (the control) only had 13% suppression.The technique of laryngotracheal topical lidocaine administered by the LITA tube can, in most cases, provide a smooth emergence from general anesthesia without coughing.

  View details for Web of Science ID 000171298300009

  View details for PubMedID 11578890

• Isosulfan blue affects pulse oximetry ANESTHESIOLOGY Vokach-Brodsky, L., Jeffrey, S. S., Lemmens, H. J., Brock-Utne, J. G. 2000; 93 (4): 1002-1003

  Abstract

  Certain vital dyes are known to cause pulse oximetry (Spo2) desaturation. The authors studied the effect of isosulfan blue (IB) on Spo2.Thirty-three women, aged 34-81 yr, who were undergoing surgery for breast cancer were studied. IB, 5 ml (50 mg), was injected intraparenchymally around the tumor area by the surgeon. A pulse oximeter was used to continuously record Spo2 values up to 130 min after IB injection. Friedman repeated-measures analysis of ranks was used to analyze the baseline Spo2 and values at 5, 10, 20, 30, 40, 50, and 60 min.Spo2 values were significantly different from baseline values at 5, 10, 20, 30, 40, 50, and 60 min (P < 0.05). In a typical patient, a maximum Spo2 decrease of 3% can be anticipated 25 min after injection of IB.After peritumoral administration of IB, 50 mg, a significant interference with Spo2 will occur.

  View details for Web of Science ID 000089671900017

  View details for PubMedID 11020754

• General anesthesia in a patient on long-term amphetamine therapy: Is there cause for concern? ANESTHESIA AND ANALGESIA Fischer, S. P., Healzer, J. M., Brook, M. W., Brock-Utne, J. G. 2000; 91 (3): 758-759

  Abstract

  Amphetamines are powerful, sympathomimetic amines that, when used chronically, can profoundly effect a patient's cardiovascular stability during anesthesia and surgery. Amphetamines are the third most widely abused class of drugs in the United States. They also have legitimate medical use for attention deficit disorder with hyperactivity, exogenous obesity, and narcolepsy. We report a case of a patient with a 40-yr history of chronic amphetamine use having undergone two general anesthesias without complication.

  View details for Web of Science ID 000088973700050

  View details for PubMedID 10960415

• Bearded Sikhs and tracheal intubation ANESTHESIA AND ANALGESIA Brock-Utne, J. G., Brodsky, J. B., Haddow, G. R. 2000; 91 (2): 494-494

  View details for Web of Science ID 000088450100051

  View details for PubMedID 10910875

• Failure to detect CO2-absorbent exhaustion: Seeing and believing ANESTHESIOLOGY Pond, D., Jaffe, R. A., Brock-Utne, J. G. 2000; 92 (4): 1196-1198

  View details for Web of Science ID 000086172700037

  View details for PubMedID 10754643

• Rewarming from hypothermia leads to elevated plasma lipopolysaccharide concentrations UNDERSEA & HYPERBARIC MEDICINE Gaffin, S. L., Dietz, F. B., Brock-Utne, J. G., Andrews, T. C., Jaffe, R. A., Steinberg, G. K., Wallace, R. F. 2000; 27 (1): 1-7

  Abstract

  Rewarming victims of hypothermia such as divers or immersion victims, participants in winter sports and military operations, and surgical patients on cardiopulmonary bypass (CPB) may lead to vascular instability, multiorgan failure, shock, and even death. While the causes of these rewarming symptoms are unknown, they may be related to bacterial lipopolysaccharide (LPS) translocated from the intestines into the circulation due to splanchnic ischemia. We have determined LPS during the cooling (to 31.5 degrees-34.0 degrees C) and rewarming phases of hypothermic surgery in 11 patients at the Stanford University Medical Center. During rewarming, there was an LPS spike in 6/11, in one more patient there was an LPS spike during surgery but not during rewarming, and in 4/11 there was no rise in LPS, i.e., a temporary endotoxemia occurred in 7/11 (63.6%) patients, usually at the commencement of rewarming. All four patients with no LPS spike received dexamethasone for at least 7 days before surgery. We propose that hypothermia reduced splanchnic blood flow (BF), causing ischemic damage to the gut wall and translocation of LPS from the gut into the vascular space. Upon rewarming, splanchnic BF is restored, the translocated LPS transits from the splanchnic to the systemic circulations as a bolus, and the gut wall is healed. No sequelae occurred in these patients because of their adequately functioning immune systems. However, had they been immunocompromised, symptoms might have occurred. Rewarming of accident victims probably also incurs a similar risk of endotoxemia, and dexamethasone may have protected the gut wall. Further studies are indicated.

  View details for Web of Science ID 000086978900001

  View details for PubMedID 10813433

• Humidification in paediatric anaesthesia PAEDIATRIC ANAESTHESIA Brock-Utne, J. G. 2000; 10 (2): 117-119

  View details for Web of Science ID 000085798600001

  View details for PubMedID 10736071

• Similar invasive procedures, but different techniques. (A potential disaster) CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE Chung, A., Brock-Utne, J. G. 1999; 46 (10): 999-999

  View details for Web of Science ID 000082917500023

  View details for PubMedID 10522596

• A non-thoracic operation for a patient with single lung transplantation 2nd International Copenhagen Pain Symposium - Aspects of Chronic Pain Haddow, G. R., Brock-Utne, J. G. WILEY-BLACKWELL PUBLISHING, INC. 1999: 960–63

  Abstract

  The number of lung transplants performed annually is increasing. It is becoming more likely that these patients will present post transplantation to anesthesiologists who have little experience in dealing with the physiological, pharmacological, medical and surgical problems that these patients present. This article discusses the management of a patient presenting for surgery after lung transplantation.

  View details for Web of Science ID 000083023200014

  View details for PubMedID 10522745

• Isosulfan blue affects pulse oximetry Vokach-Brodsky, L., JEFFREY, S., Lemmens, H. J., Brock-Utne, J. G. LIPPINCOTT WILLIAMS & WILKINS. 1999: U465–U465

  View details for Web of Science ID 000082480601170

• Treatment of mild hypothermia using the "Thermo-STAT (TM)" facilitates earlier discharge from the post anesthesia care unit Mathur, A., Grahn, D., Dillingham, M. F., Brock-Utne, J. G. LIPPINCOTT WILLIAMS & WILKINS. 1999: U480–U480

  View details for Web of Science ID 000082480601230

• A non-invasive means to effectively restore normothermia in cold stressed individuals: A preliminary report JOURNAL OF EMERGENCY MEDICINE Soreide, E., Grahn, D. A., Brock-Utne, J. G., Rosen, L. 1999; 17 (4): 725-730

  Abstract

  The combined application of subatmospheric pressure and heat to a forearm and hand has been previously reported to be an effective method for restoring normothermia in hypothermic postoperative patients. The objective of this study was to determine whether this technique also could be useful for the treatment of accidental hypothermia. Four otherwise healthy cold-stressed soldiers (core temperature <36.0 degrees C) were studied. In all four cases, application of the subatmospheric pressure induced an immediate local distention of the subcutaneous vasculature of the hand and fingers. Tympanic temperature reached a plateau in a normothermic range within 15 min in all subjects. The subjects also noted rapid elimination of shivering and improvement in subjective assessment of thermal comfort. These results are encouraging and warrant further investigation of the technique.

  View details for Web of Science ID 000082189300020

  View details for PubMedID 10431966

• More tips for users of the Bullard (TM) laryngoscope - In response ANESTHESIA AND ANALGESIA Habibi, A., Bushell, E., Jaffe, R. J., Giffard, R. G., Brock-Utne, J. G. 1999; 89 (1): 267-267

  View details for Web of Science ID 000081101100079

• Negative-pressure pulmonary edema: A potential mazard in patients undergoing ECT JOURNAL OF ECT Cochran, M., Debattista, C., Schmiesing, C., Brock-Utne, J. G. 1999; 15 (2): 168-170

  View details for Web of Science ID 000084423300012

  View details for PubMedID 10378160

• Another use of a bronchoscopic swivel adapter ANESTHESIA AND ANALGESIA Torralva, P. R., Macario, A., Brock-Utne, J. G. 1999; 88 (5): 1187-1188

  View details for Web of Science ID 000080063000043

  View details for PubMedID 10320195

• Peri-operative steroid supplementation ANAESTHESIA Ratner, E. F., Brock-Utne, J. G. 1999; 54 (5): 507-507

  View details for Web of Science ID 000080626500044

  View details for PubMedID 10995171

• A comparison of the onset and clinical duration of high doses of cisatracurium and rocuronium JOURNAL OF CLINICAL ANESTHESIA Lighthall, G. K., Jamieson, M. A., Katolik, J., Brock-Utne, J. G. 1999; 11 (3): 220-225

  Abstract

  To determine the onset and clinical duration of cisatracurium and rocuronium in equipotent doses in balanced opioid/isoflurane anesthesia.Randomized, controlled study.University hospital.40 healthy patients scheduled for elective surgery.Patients underwent anesthesia induction with thiopental or propofol with a cisatracurium intubating dose of either 0.15 or 0.2 mg/kg or a rocuronium dose of either 0.9 or 1.2 mg/kg. These doses correspond to three and four times the ED95 dose.The onset time and time to 25% recovery of baseline first twitch in a train-of-four were determined using an accelerometric sensor. Rocuronium had a faster onset time that cisatracurium at equipotent doses (3 x ED95: 134 vs. 220 sec respectively, and at 4 x ED95: 95 vs. 162 sec). Recovery tended to be faster, but not statistically different for cisatracurium compared to rocuronium.With equipotent intubating doses of rocuronium and cisatracurium, rocuronium produces a more rapid onset of muscle relaxation. The data suggest a tendency toward more rapid clinical recovery of cisatracurium compared to equipotent doses of rocuronium, although these differences were not statistically significant.

  View details for Web of Science ID 000081512700008

  View details for PubMedID 10434218

• Another use of the "bair hugger" CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE Gerstner, M., Eckinger, P., Tew, P., Brock-Utne, J. G. 1999; 46 (2): 200-200

  View details for Web of Science ID 000078928600025

  View details for PubMedID 10084009

• Two tips for users of Bullard (TM) intubating laryngoscope ANESTHESIA AND ANALGESIA Habibi, A., Bushell, E., Jaffe, R. A., Giffard, R. G., Brock-Utne, J. G. 1998; 87 (5): 1206-1208

  View details for Web of Science ID 000076692300044

  View details for PubMedID 9806711

• Recovery from mild hypothermia can be accelerated by mechanically distending blood vessels in the hand JOURNAL OF APPLIED PHYSIOLOGY Grahn, D., Brock-Utne, J. G., Watenpaugh, D. E., Heller, H. C. 1998; 85 (5): 1643-1648

  Abstract

  Peripheral vasoconstriction decreases thermal conductance of hypothermic individuals, making it difficult to transfer externally applied heat to the body core. We hypothesized that increasing blood flow to the skin of a hypothermic individual would enhance the transfer of exogenous heat to the body core, thereby increasing the rate of rewarming. External auditory meatus temperature (TEAM) was monitored in hypothermic subjects during recovery from general anesthesia. In 10 subjects, heat (45-46 degreesC, water-perfused blanket) was applied to a single forearm and hand that had been placed in a subatmospheric pressure environment (-30 to -40 mmHg) to distend the blood vessels. Heat alone was applied to control subjects (n = 6). The application of subatmospheric pressure resulted in a 10-fold increase in rewarming rates as determined by changes in TEAM [13.6 +/- 2.1 (SE) degreesC/h in the experimental group vs. 1.4 +/- 0.1 degreesC/h in the control group; P < 0.001]. In the experimental subjects, the rate of change of TEAM decreased sharply as TEAM neared the normothermic range.

  View details for Web of Science ID 000076875900008

  View details for PubMedID 9804564

• Evoked potential monitoring and EKG: A case of a serious "cardiac arrhythmia" ANESTHESIOLOGY Diachun, C. A., Brock-Utne, J. G., Lopez, J. R., Ceranski, J. A. 1998; 89 (5): 1270-1272

  View details for Web of Science ID 000076891400033

  View details for PubMedID 9822022

• "Damping" of an arterial line: An unlikely cause ANESTHESIA AND ANALGESIA Truelsen, K. S., Brock-Utne, J. G. 1998; 87 (4): 979-980

  View details for Web of Science ID 000076234300051

  View details for PubMedID 9768810

• No change in ST segment during retro- or peri-bulbar block with IV sedation for ophthalmic surgery (A study in elderly patients with heart disease) Habibi, A., Cantwell, A., Katolik, J., Vokach-Brodsky, L., Brock-Utne, J. G. LIPPINCOTT WILLIAMS & WILKINS. 1998: U131–U131

  View details for Web of Science ID 000075810900038

• The aetiology and prevention of peri-operative corneal abrasion ANAESTHESIA Brock-Utne, J. G. 1998; 53 (8): 829-829

  View details for Web of Science ID 000075269900031

  View details for PubMedID 9797542

• Liquid crystal temperature indicators - a potentially serious problem in paediatric anaesthesia CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE Claure, R. E., Brock-Utne, J. G. 1998; 45 (8): 823-823

  View details for Web of Science ID 000076367400026

  View details for PubMedID 9793681

• Another potential problem with the "hidden iv" CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE Kim, A., Brock-Utne, J. G. 1998; 45 (5): 495-496

  View details for Web of Science ID 000073543400020

  View details for PubMedID 9598269

• Postoperative epidural injection of saline can shorten postanesthesia care unit time for knee arthroscopy patients Feminist Theory and Music 4 Conference Brock-Utne, J. G., Macario, A., Dillingham, M. F., Fanton, G. S. W B SAUNDERS CO-ELSEVIER INC. 1998: 247–51

  Abstract

  The goal of this prospective, double-blind study was to ascertain if the postanesthesia care unit (PACU) stay of outpatients receiving epidural anesthesia for knee arthroscopy is decreased by injection of epidural saline at the end of the case.Twenty healthy patients undergoing knee arthroscopy received lumbar epidural anesthesia with 2% lidocaine. At the end of surgery, in a double-blind design, group 1 patients (intervention group) received 20 mL 0.9% saline injected into the epidural catheter. Patients in group 2 (control group) had 1 mL 0.9% saline injected into the epidural catheter. In the PACU, the epidural catheter was removed, and motor block was assessed at 15-minute intervals according to the Bromage scale. Standard discharge criteria for our ambulatory surgery center were followed.Patients who received 20 mL epidural 0.9% saline remained in phase I (intensive nursing) 83 +/- 8 minutes compared with control patients who stayed 110 +/- 8 minutes (P < .01). Nonmedical issues related to the unavailability of the patients transportation or waiting for medications to be issued from the pharmacy delayed discharge from phase II (non-nursing) in 70% of group 1 patients and 60% of group 2 patients. Time to actual hospital dismissal for group I was 119 +/- 14 minutes, compared with 159 +/- 13 minutes (P < .05) for group 2.Patients receiving epidural anesthesia for knee arthroscopy had a shorter PACU stay if they received an injection of saline into the epidural space at the end of surgery.

  View details for PubMedID 9613534

• Twelve hours of gastric ventilation: A recipe for disaster (a suggested remedy) PAEDIATRIC ANAESTHESIA Crockett, D. E., Tays, R., Brock-Utne, J. G. 1998; 8 (2): 171-173

  Abstract

  A forty-three-day-old infant was intubated by the Neonatal Intensive Care Unit (NICU) staff. A nasogastric tube was in place for the duration. The patient's vital signs remained stable during 12 h of positive pressure ventilation. A Broviac catheter placement was scheduled in the NICU. The position of the tracheal tube (TT) was not verified prior to induction of anaesthesia. After the induction, the patient's condition deteriorated. The TT was found to be positioned within the oesophagus. A near catastrophe was successfully averted by discovering the malpositioned TT and replacing it with a properly positioned TT. We believe that had we clamped the existing nasogastric tube preoperatively, a noticeable abdominal distention would have occurred alerting us to a malpositioned TT. We suggest that clamping a preexisting nasogastric tube may have merit to alert one to a malpositioned TT.

  View details for Web of Science ID 000072681600016

  View details for PubMedID 9549748

• An airway management device: The laryngeal mask airway - A review JOURNAL OF INTENSIVE CARE MEDICINE Schmiesing, C. A., Brock-Utne, J. G. 1998; 13 (1): 32-43

  View details for Web of Science ID 000071440100003

• The first structure-function approach to drug design in anaesthesia - Dr David S. Savage and pancuronium bromide ANAESTHESIA Brown, D. L., Brock-Utne, J. G. 1997; 52 (12): 1202-1204

  View details for Web of Science ID 000070998100014

  View details for PubMedID 9485976

• Cricoid pressure CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE BROCKUTNE, J. G. 1997; 44 (11): 1219-1219

  View details for Web of Science ID A1997YG16300021

  View details for PubMedID 9398968

• Intraoperative insufflation of the stomach: Another approach using a jet ventilator ANESTHESIOLOGY BROCKUTNE, J. G., Vierra, M. 1997; 87 (5): 1265-1265

  View details for Web of Science ID A1997YE49900049

  View details for PubMedID 9366492

• Reduction of propofol injection pain with a double lumen IV set JOURNAL OF CLINICAL ANESTHESIA Angst, M. S., Mackey, S. C., Zupfer, G. H., Tataru, C. D., BROCKUTNE, J. G. 1997; 9 (6): 462-466

  Abstract

  To investigate if the use of a new double lumen i.v. set (DLIS) decreases the incidence of propofol injection pain compared with single lumen i.v. set (SLIS) administration.Prospective, randomized, double-blinded study.Operating rooms in a university hospital.50 adult ASA physical status I and II patients of both genders undergoing general anesthesia for elective surgery.Patients were injected with propofol either through a DLIS or a SLIS.Three different pain indices were recorded to be present or absent: (1) verbal report of pain during propofol injection (2) grimacing during propofol injection, and (3) recall of injection pain in the recovery room. When the DLIS was used, the incidence of verbal pain, grimacing during propofol injection, and recall of pain during recovery were lowered significantly by 53%, 46%, and 52%, respectively (chi square analysis of contingency table with Yates correction, p < 0.05).The DLIS significantly reduced the incidence of propofol injection pain compared with SLIS. Further studies are indicated to evaluate the cost-effectiveness of this device.

  View details for PubMedID 9278832

• Inspired oxygen concentrations with or without an oxygen economizer during ether draw-over anaesthesia ANAESTHESIA AND INTENSIVE CARE Khaing, T. T., Yu, S., BROCKUTNE, J. G. 1997; 25 (4): 417-419

  Abstract

  An oxygen economizer tube is attached to draw-over vaporizers and acts as a reservoir of supplemental oxygen. The clinical importance of the presence or absence of the economizer tube (volume 130 ml) has not been adequately studied in manually ventilated patients using ether from an Ohmeda Cyprane Portable Anesthesia Complete (PAC) draw-over vaporizer. A total of sixteen patients ASA 1-2, undergoing elective surgery for peripheral orthopaedic procedures were studied with and without an economizer tube. Each patient acted as his or her own control. Standard procedures were used for anaesthetic induction with muscle relaxant, endotracheal intubation and anaesthetic maintenance. Supplemental oxygen was supplied by an oxygen concentrator. Using the draw-over vaporizer without an oxygen economizer tube, there was a slight increase in FiO2 of 20%, 23%, 27%, 30%, 33% and 33%, with increasing oxygen supplementation of 0 to 5 l/min, respectively. With an economizer tube, the FiO2 values increased to 20%, 26%, 35%, 46%, 54% and 66% at 0 to 5 l/min of oxygen respectively. The FiO2 values were significantly different at 3, 4, and 5 l/min (P < 0.05), showing the potential advantages of an oxygen economizer tube attached to a draw-over vaporizer in this setting. No significant differences were seen in the oxygen saturations of these healthy patients with or without an oxygen economizer.

  View details for Web of Science ID A1997XU03000016

  View details for PubMedID 9288387

• Biting on ET tubes ANAESTHESIA AND INTENSIVE CARE BROCKUTNE, J. G. 1997; 25 (3): 309-309

  View details for Web of Science ID A1997XF47300022

  View details for PubMedID 9209620

• Gastric foreign body: A potential risk when using transesophageal echo ANESTHESIA AND ANALGESIA Brook, M., Chard, P. S., BROCKUTNE, J. G. 1997; 84 (6): 1389-1389

  View details for Web of Science ID A1997XB41400042

  View details for PubMedID 9174329

• Intraoperative epidural catheter malfunction in two obese patients ACTA ANAESTHESIOLOGICA SCANDINAVICA Leith, P., Sanborn, R., BROCKUTNE, J. G. 1997; 41 (5): 651-653

  Abstract

  Using a combined general anesthesia/epidural technique, two cases of intraoperative malfunctioning epidural catheters in obese patients are presented. After the epidural was found to be malfunctioning, the anesthesiologist placed the palm of both hands underneath the patients' lumbar and thoracic area. The epidural catheter with tape and subcutaneous tissue was pulled in both cases towards the head. In each case, this simple maneuver made the catheter function again. In conclusion, this simple corrective maneuver should be attempted prior to discarding the epidural anesthetic technique.

  View details for Web of Science ID A1997XC32600018

  View details for PubMedID 9181171

• A comparison of simple tests to distinguish cerebrospinal fluid from saline CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE Walker, D. S., BROCKUTNE, J. G. 1997; 44 (5): 494-497

  Abstract

  This prospective study was undertaken to determine if anesthesiologists of different levels of training, using simple tests, can distinguish cerebrospinal fluid (CSF) from saline.Thirty-two anaesthetists, divided into four groups, dependent upon levels of training, participated in the study. Each was asked to distinguish saline from an artificial CSF solution using four different tests: tactile temperature, glucose strip, pH strip, and turbidity when mixed with thiopental.Participants identified cerebrospinal fluid correctly with 84% accuracy using the temperature test, 97% using the glucose test, 91% using the pH test, and 50% using the thiopentone test. More than half of the participants guessed while using the thiopentone test, and those who did not guess were only 47% accurate.Level of training made no difference in distinguishing CSF from saline. No one test was 100% reliable. Clinical utility of the thiopentone test appears to be limited. The temperature, glucose, and pH tests, when used together, appear to be a useful way of distinguishing CSF from saline.

  View details for Web of Science ID A1997WZ15200008

  View details for PubMedID 9161743

• Does ketorolac prophylaxis prevent succinylcholine induced myalgias following electroconvulsive therapy? Russo, C. M., Debattista, C., Barry, J., Samuels, S., BROCKUTNE, J. G. LIPPINCOTT WILLIAMS & WILKINS. 1997: S20–S20

  View details for Web of Science ID A1997WF78000020

• No change in ST segment during instillation of eyedrops for ophthalmic surgery: A study in elderly patients with heart disease (is present software/technology sufficiently sensitive) JOURNAL OF CLINICAL ANESTHESIA Botz, G. H., Miser, J., Hoopes, S., Zweig, S., BROCKUTNE, J. G. 1996; 8 (8): 631-633

  Abstract

  To study the safety of instillation of eyedrops prior to ophthalmic surgery, which may potentially affect myocardial function, using continuous ST segment recording.Prospective study.Ambulatory surgery preoperative area at a university hospital.30 nonpremedicated ASA status III adults (aged 73 to 92 years) scheduled for cataract surgery with monitored anesthesia care (MAC).All patients were given ophthalmic drugs consisting of phenylephrine 2.5%, flubiprofen 0.03%, mydriacyl 1%, and cyclopentolate 1%.ST segments were continuously monitored after the instillation of the eyedrops for a period of up to 15 minutes. A change of 2 mm or more in ST segments from baseline was considered significant. Results showed no significant change in ST segment. No patient reported any new cardiac symptoms or showed any evidence of dysrhythmias or hemodynamic changes.The lack of significant finding most likely reflects the safety of these ophthalmic drops in their present dilute concentration, but it is also possible that the software and/or monitors used were not sensitive enough in their current configuration to detect possible subtle changes. Based on the results of this study, we conclude that the preoperative ophthalmic drugs used in our institution do not seem to have any adverse cardiovascular effects in this elderly patient population who are about to undergo cataract surgery with MAC.

  View details for Web of Science ID A1996VZ90900003

  View details for PubMedID 8982889

• Tourniquet release: Systemic and metabolic effects ACTA ANAESTHESIOLOGICA SCANDINAVICA Townsend, H. S., Goodman, S. B., Schurman, D. J., Hackel, A., BROCKUTNE, J. G. 1996; 40 (10): 1234-1237

  Abstract

  The pneumatic tourniquet produces ischemic changes in limbs. The effects of tourniquet release on systemic blood pressure and metabolic parameters were studied in 11 adult patients undergoing total knee replacement under general anesthesia. Mean arterial pressure (MAP) decreased rapidly after the release of the tourniquet, becoming significant at 3 min and remaining significantly depressed up to 15 min post release. Arterial pH, PaO2, PaCO2, lactate acid, and potassium changed significantly after the release, but normalized within 30 min. These results are notably different from a previous study in a similar patient population undergoing knee replacement under epidural anesthesia. Compared to patients under epidural anesthesia, patients receiving general anesthesia with mechanical ventilation are unable to compensate for the metabolic load caused by the tourniquet release, as the latter group are unable to alter their ventilatory rate. In elderly patients with decreased cardio-pulmonary reserve, this may be of clinical importance.

  View details for PubMedID 8986188

• Chewing gum prior to anaesthesia - Is not age restricted CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE Tays, R., BROCKUTNE, J. G. 1996; 43 (10): 1080-1080

  View details for Web of Science ID A1996VL88700023

  View details for PubMedID 8896867

• Accelerated rate of rewarming with local application of negative pressure and heat to a distal appendage in postoperative patients. Grahn, D. A., Kumm, J., BrockUtne, J. G. LIPPINCOTT-RAVEN PUBL. 1996: A409

  View details for Web of Science ID A1996VM46600409

• Preoperative inhalation - An airway concern CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE MALLAT, A. M., Roberson, J., BROCKUTNE, J. G. 1996; 43 (7): 691-693

  Abstract

  Cannabis Sativa (marijuana) may cause a variety of respiratory disorders including uvular oedema. This case illustrates that uvular oedema secondary to marijuana inhalation may cause a potentially serious postoperative clinical problem.A healthy 17-yr-old man who inhaled marijuana prior to general anaesthesia. In the recovery room, after an uneventful general anaesthetic, acute uvular oedema resulted in post operative airway obstruction and admission to hospital. The uvular oedema was treated successfully with dexamethasone.Recent inhalation of marijuana before general anaesthesia may cause acute uvular oedema and post operative airway obstruction. The uvular oedema can be easily diagnosed and treated.

  View details for Web of Science ID A1996UU21400009

  View details for PubMedID 8807175

• Failure of steroid supplementation to prevent operative hypotension in a patient receiving chronic steroid therapy ANESTHESIA AND ANALGESIA Ratner, E. F., Allen, R., Mihm, F. G., BROCKUTNE, J. G. 1996; 82 (6): 1294-1296

  View details for PubMedID 8638809

• Clear fluids, not breakfast, before surgery ACTA ANAESTHESIOLOGICA SCANDINAVICA BROCKUTNE, J. G. 1996; 40 (5): 507-508

  View details for Web of Science ID A1996UQ89000001

  View details for PubMedID 8792876

• Forget the costs: Use what is best - Reply ANESTHESIOLOGY Macario, A., Chang, P., Stempel, D., BROCKUTNE, J. 1996; 84 (5): 1258-1259

  View details for Web of Science ID A1996UJ07100032

• Raising the operating table causing a sudden anesthesia system obstruction ANESTHESIA AND ANALGESIA Silver, L., Lopes, N., BROCKUTNE, J. 1996; 82 (5): 1107-1108

  View details for Web of Science ID A1996UH19500048

  View details for PubMedID 8610884

• Ketorolac and propofol anesthesia in a patient taking chronic monoamine oxidase inhibitors JOURNAL OF CLINICAL ANESTHESIA Fischer, S. P., MANTIN, R., BROCKUTNE, J. G. 1996; 8 (3): 245-247

  Abstract

  There is continued controversy regarding the concurrent use of monoamine oxidase inhibitors (MAOIs) and opioids in anesthesia. MAOIs are being used in both psychiatry and also in the treatment of Parkinson's disease. The adverse interaction of meperidine with MAOIs is well described in the literature. Several other opioids used in anesthesia have been reported as potentially safe and also implicated in interaction with MAOIs. We present a case report using ketorolac as a nonopioid analgesic during a general anesthesia combined with midazolam and propofol in a successful approach in a patient continuing MAOI therapy.

  View details for Web of Science ID A1996UG88200015

  View details for PubMedID 8703462

• Paediatric anaesthetic breathing systems PAEDIATRIC ANAESTHESIA Lin, Y. C., BROCKUTNE, J. G. 1996; 6 (1): 1-5

  View details for Web of Science ID A1996TP25700001

  View details for PubMedID 8839081

• Anaesthetic breathing systems for children - Reply PAEDIATRIC ANAESTHESIA Lin, Y. C., BROCKUTNE, J. G. 1996; 6 (4): 346-346

  View details for Web of Science ID A1996UX36600025

• ANOTHER USE FOR THE NERVE STIMULATOR ANESTHESIA AND ANALGESIA Keating, M., BROCKUTNE, J. 1995; 81 (6): 1312-1312

  View details for Web of Science ID A1995TH07400039

  View details for PubMedID 7486128

• COMPARISON OF ESTIMATED VARIABLE COSTS IS A SURROGATE FOR ACTUAL COST EXPERIENCE - REPLY ANESTHESIOLOGY Macario, A., Chang, P., Stempel, D., BROCKUTNE, J. 1995; 83 (6): 1387-1387

  View details for Web of Science ID A1995TJ32900053

• PAIN OUTCOMES AFTER THORACOTOMY - LUMBAR EPIDURAL HYDROMORPHONE VERSUS INTRAPLEURAL BUPIVACAINE JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA Gaeta, R. R., Macario, A., Brodsky, J. B., BROCKUTNE, J. G., MARK, B. D. 1995; 9 (5): 534-537

  Abstract

  To evaluate postthoractomy analgesia in patients receiving lumbar epidural hydromorphone versus intrapleural bupivacaine.A randomized, prospective, double-blind study.A university-affiliated medical center.Twenty patients undergoing lateral thoracotomy for either pulmonary wedge resection, lobectomy, or pneumonectomy.Nine patients received epidural hydromorphone, and 11 patients received intrapleural bupivacaine in the postoperative period.Severity of pain was assessed using a visual analog pain scale (VAPS) (0 to 100 mm) at 1, 3, and 5 hours. Patients receiving epidural hydromorphone had a statistically significant improvement in VAPS scores. Patients who received intrapleural bupivacaine did not achieve a significant reduction in pain scores. Nine of 11 patients in the intrapleural bupivacaine group had "failed" postoperative analgesia as defined by a VAPS greater than 30. Only 3 of 9 patients in the continuous epidural hydromorphone group had "failed" analgesia.Epidural hydromorphone is superior to intrapleural bupivacaine in achieving satisfactory pain outcomes during the first 5 hours after thoracotomy.

  View details for PubMedID 8547554

• WRAPPING OF THE LEGS REDUCES THE DECREASE IN BLOOD-PRESSURE FOLLOWING SPINAL-ANESTHESIA - A STUDY IN MEN UNDERGOING UROLOGIC PROCEDURES REGIONAL ANESTHESIA Pollard, J., BROCKUTNE, J. 1995; 20 (5): 402-406

  Abstract

  Hypotension after induction of spinal anesthesia remains a common and a potentially serious complication despite acute expansion of intravascular volume. The current study evaluated the role of leg wrapping as an adjunct to acute volume expansion.Twenty-four men undergoing elective urologic procedures were randomly assigned to two groups. Patients in the experimental group had their legs wrapped tightly while those in the control group had their legs wrapped loosely with elastic bandages immediately following spinal anesthesia. Significant hypotension was defined as a decrease in mean arterial pressure to less than 65 mm Hg.Systolic blood pressure was significantly lower (P < .05) in the control group at 4, 5, 7, 9, 10, 12.5, and 15 minutes following spinal injection. Diastolic blood pressure was significantly lower (P < .05) in control subjects at 7, 8, 10, and 15 minutes following the block. None of the patients in either group became hypotensive following removal of the elasticized bandages.Tightly wrapping the legs with elastic bandages immediately after placing spinal anesthesia in mature men is a safe and efficient adjunct in preventing hypotension.

  View details for Web of Science ID A1995RW95100007

  View details for PubMedID 8519717

• POSTOPERATIVE EPIDURAL SALINE HASTENS TIME DISCHARGE IN PATIENTS ELECTIVE KNEE ARTHROSCOPY MACARIO, A., DILLINGHAM, M. F., FANTON, G. S., BROCKUTNE, J. G. LIPPINCOTT-RAVEN PUBL. 1995: A13

  View details for Web of Science ID A1995RX68500013

• A COST-ANALYSIS OF THE LARYNGEAL MASK AIRWAY FOR ELECTIVE SURGERY IN ADULT OUTPATIENTS ANESTHESIOLOGY Macario, A., Chang, P. C., STEMPEL, D. B., BROCKUTNE, J. G. 1995; 83 (2): 250-257

  Abstract

  Since the introduction of the laryngeal mask airway (LMA) into the United States in 1991, the device has become widely used in anesthesia practice. The purpose of this economic analysis was to use existing data to evaluate the costs of the LMA relative to three other common airway management techniques and to identify the variables that had the greatest effect on cost efficiency.We evaluated four airway management techniques for healthy adults receiving an isoflurane-nitrous oxide-oxygen anesthetic for elective outpatient surgery: (1) LMA with spontaneous ventilation; (2) face mask with spontaneous ventilation; (3) tracheal intubation after succinylcholine with subsequent spontaneous ventilation; and (4) tracheal intubation after nondepolarizing neuromuscular blockade and controlled ventilation. We analyzed published clinical studies of the LMA and obtained cost data from Stanford University Medical Center. The best available estimates of the independent variables were incorporated into a baseline case. For each airway technique we derived cost equations that excluded costs common to all four techniques.Relative to airway management with an LMA, calculated values for the baseline analysis included additional isoflurane costs for use of a face mask ($ 0.12/min) and for tracheal intubation with ($ 0.043/min) and without neuromuscular blockade ($ 0.06/min). With a neuromuscular blocking drug cost of $ 0.21/min and an LMA cost per use of $ 20, the face mask with spontaneous ventilation was the cost-efficient airway choice for anesthetics lasting as long as 100 min. Increasing the LMA reuse rate from 10 to 25 made the LMA the least costly airway technique for cases lasting more than 70 min.If the LMA is reused 40 times, the LMA is the cost-efficient airway choice for outpatients receiving an isoflurane-nitrous oxide-oxygen anesthetic lasting longer than 40 min. This finding does not change if the cost of neuromuscular blockade or the incidence of airway-related complications is varied over a clinically relevant range.

  View details for Web of Science ID A1995RM71100004

  View details for PubMedID 7631945

• AIRWAYS, PAPER CLIPS, AND NASOGASTRIC TUBES - IN RESPONSE ANESTHESIA AND ANALGESIA Manos, S., Jaffe, R., BROCKUTNE, J. 1995; 81 (1): 209-209

  View details for Web of Science ID A1995RF82000055

• IS NITROUS-OXIDE SAFE FOR BONE-MARROW HARVEST ANESTHESIA AND ANALGESIA Lederhaas, G., BROCKUTNE, J. G., Negrin, R. S., Riley, E., Brodsky, J. B. 1995; 80 (4): 770-772

  Abstract

  Patients with non-Hodgkins lymphoma undergoing autologous bone marrow harvest were studied in a prospective, randomized fashion. All patients received a general anesthetic consisting of intravenous thiopental, fentanyl, and vecuronium and were ventilated with oxygen and isoflurane. Group I (19) patients also were ventilated with nitrous oxide (70%) whereas patients in Group II (19) did not receive nitrous oxide. Bone marrow samples were obtained at the beginning and end of the harvest. Viability of bone marrow mononuclear cells was assessed with a colony-forming unit-granulocyte macrophage (CFU-GM) assay, CFU-GM growth is a marker for myeloid progenitor cells and is dependent on intact deoxyribonucleic acid synthesis. Rate of neutrophil engraftment after autologous bone marrow transplantation was also studied. Both groups of patients were statistically similar in age, weight, anesthetic duration, CFU-GM counts at both sample draws, and the time for successful engraftment. There appears to be no difference in bone marrow viability as assayed by both CFU-GM colony growth and engraftment in human bone marrow exposed to a general anesthetic with nitrous oxide.

  View details for PubMedID 7893033

• INCIDENCE OF GRAM-NEGATIVE BACTEREMIA IN SEPSIS SYNDROME ANAESTHESIA BROCKUTNE, J. G. 1995; 50 (3): 267-268

  View details for Web of Science ID A1995QL29700036

  View details for PubMedID 7717509

• EPIDURAL AIR INJECTION ASSESSED BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY REGIONAL ANESTHESIA Jaffe, R. A., Siegel, L. C., Schnittger, L., PROPST, J. W., BROCKUTNE, J. G. 1995; 20 (2): 152-155

  Abstract

  The object of this study, using transesophageal echocardiography (TEE) in anesthetized patients, was to investigate the occurrence of venous air embolism (VAE) when air is injected into the epidural space.Six patients between the ages of 18 and 50 years (ASA I-II) undergoing general anesthesia in a supine position for nonthoracic surgical procedures were studied. Prior to general anesthesia, an epidural catheter was placed into the epidural space using a Tuohy needle and a standard saline loss-of-resistance technique. Following verification of proper catheter placement, general anesthesia was induced and the trachea intubated. Thereafter, a TEE probe was inserted into the esophagus. After a 10-minute control period, and during continuous TEE videotape recording, 5 mL of air was rapidly injected into the epidural space through the epidural catheter. This was followed 10 minutes later by the epidural injection of 5 mL of room-temperature preservative-free saline. Microbubble echo targets were quantified in a range from 0 to 4+.Venous air microbubble emboli appeared in the circulation within 15 seconds after injecting either air or saline into the epidural space.No evidence of clinically significant VAE was seen in any patient. The results suggest that drugs injected into the epidural space may have unexpectedly easy access to the venous circulation with a potential to produce unwanted systemic effects. Clinicians should be alert to the possibility that local anesthetics, or any other drug placed epidurally, may rapidly enter the systemic circulation even without the intravenous placement of an epidural catheter.

  View details for Web of Science ID A1995QP69300012

  View details for PubMedID 7605763

• AN ALTERNATIVE TO THE GUM ELASTIC BOUGIE AND/OR THE JET STYLET ANESTHESIA AND ANALGESIA MANOS, S. J., Jaffe, R. A., BROCKUTNE, J. G. 1994; 79 (5): 1017-1017

  View details for Web of Science ID A1994PN57800036

  View details for PubMedID 7978382

• ANESTHETISTS OVERESTIMATE BLOOD-LOSS CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE Macario, A., BROCKUTNE, J. 1994; 41 (10): 1017-1018

  View details for Web of Science ID A1994PL75500024

  View details for PubMedID 8001204

• COMPARISON OF ARTERIAL TONOMETRY WITH RADIAL ARTERY CATHETER MEASUREMENTS OF BLOOD-PRESSURE IN ANESTHETIZED PATIENTS ANESTHESIOLOGY Siegel, L. C., BROCKUTNE, J. G., Brodsky, J. B. 1994; 81 (3): 578-584

  Abstract

  Arterial tonometry has been introduced for continuous noninvasive measurement of blood pressure. The accuracy of this method depends on the performance of two components: a piezoelectric crystal array and an oscillometric cuff. This study evaluates overall performance of arterial tonometry in terms of the performance of these two components by comparing it with simultaneous recording of blood pressure from an intraarterial catheter.Seventeen adult patients were studied during general anesthesia. Blood pressure was measured with an intraarterial catheter and with an arterial tonometry system. Analog pressure waveforms were sampled at 100 Hz. Blood pressure measurements obtained by oscillometry were recorded by computer. Comparisons of mean blood pressure on a beat-by-beat basis were made with and without correction for the calibration error introduced by oscillometry.The difference between pairs of blood pressure determined by arterial tonometry and intraarterial measurement was 1.3 +/- 9.4 mmHg (mean +/- SD, bias +/- precision) with 88,158 pairs of measurements. The difference between blood pressure determined by oscillometry and intraarterial measurement was 2.4 +/- 7.5 mmHg (mean +/- SD) with 401 comparisons. After correcting for calibration error, the difference between the tonometry measurements and intraarterial measurements was -1.0 +/- 5.6 mmHg. Continuous episodes of discrepancy from intraarterial measurements in excess of 10 mmHg and lasting 5-60 s occurred 4.6 +/- 0.8 times per hour with tonometry and 12.6 +/- 1.4 times per hour with oscillometry.Discrepancies in blood pressure readings by arterial tonometry versus intraarterial measurement result from both the piezoelectric crystal array and the oscillometry used for calibration. Accuracy for individual measurement is inferior to oscillometry alone. The ability to detect significant changes of blood pressure more rapidly than with oscillometry alone is limited by the accuracy of the piezoelectric crystal component but is enhanced by the reduced interval between measurements.

  View details for Web of Science ID A1994PG11900007

  View details for PubMedID 8092502

• BUCKING IS SUPPRESSED DURING EMERGENCE FROM GENERAL-ANESTHESIA - LARYNGOTRACHEAL LIDOCAINE THROUGH A MODIFIED ENDOTRACHEAL-TUBE TUNINK, B., BROCKUTNE, J. G. LIPPINCOTT-RAVEN PUBL. 1994: A489

  View details for Web of Science ID A1994PJ09100488

• ELIMINATION OF 12-FR AND 24-FR ESOPHAGEAL STETHOSCOPES FROM ANESTHETIC PRACTICE (AN ATTEMPT AT COST-CONTAINMENT) ANESTHESIA AND ANALGESIA Macario, A., BROCKUTNE, J. G. 1994; 79 (2): 393-393

  View details for Web of Science ID A1994NZ33700043

  View details for PubMedID 7639391

• FIBEROPTIC ILLUMINATION SYSTEMS CAN SERVE AS A SOURCE OF SMOLDERING FIRES JOURNAL OF CLINICAL MONITORING Eggen, M. A., BROCKUTNE, J. G. 1994; 10 (4): 244-246

  View details for Web of Science ID A1994NY00400005

  View details for PubMedID 7931454

• PULMONARY-EDEMA AFTER ABSORBING CRYSTALLOID IRRIGATING FLUID DURING LAPAROSCOPY ANESTHESIA AND ANALGESIA Healzer, J. M., Nezhat, C., Brodsky, J. B., BROCKUTNE, J. G., Seidman, D. S. 1994; 78 (6): 1207-1207

  View details for Web of Science ID A1994NN59500048

  View details for PubMedID 8198294

• SEGMENTAL WALL-MOTION ABNORMALITIES IN PATIENTS UNDERGOING TOTAL HIP-REPLACEMENT - CORRELATIONS WITH INTRAOPERATIVE EVENTS ANESTHESIA AND ANALGESIA PROPST, J. W., Siegel, L. C., Schnittger, I., FOPPIANO, L., Goodman, S. B., BROCKUTNE, J. G. 1993; 77 (4): 743-749

  Abstract

  We examined the effect of methylmethacrylate cement on venous embolization and cardiac function in 20 patients having total hip arthroplasty under general anesthesia. Segmental wall motion abnormalities and intracardiac targets (presumably emboli) were investigated by making videotaped recordings of the transgastric short axis and longitudinal 4-chamber views of the heart with transesophageal echocardiography at different points during surgery. The incidence of segmental wall motion abnormalities was the most frequent during insertion of cemented femoral prostheses (8 of 14 patients had wall motion abnormalities). This was significantly different from baseline measurements taken at the beginning of surgery (P < 0.05). In addition, there were also significantly more segmental wall motion abnormalities in patients having a cemented femoral component compared to those having an uncemented femoral prosthesis (P < 0.05). The incidence of wall motion abnormalities during acetabular and femoral reaming and during wound closure was not significantly different from baseline. Intracardiac targets (emboli) were seen in all 20 patients during surgery. The largest number of emboli occurred during reaming of the femur and during insertion of the femoral prosthesis. Significantly more emboli were seen with cemented components (P < 0.02). Most emboli were small (< 2 mm) and appeared similar to the microbubbles produced by agitating saline with a small amount of air. Six patients also had larger (> 5 mm) emboli that appeared to be solid material. One patent foramen ovale was detected (5% incidence). There were no adverse cardiac or neurologic events, and heart rate and arterial blood pressure remained within normal limits throughout surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

  View details for PubMedID 8214658

• DOES VENOUS AIR-EMBOLISM OCCUR DURING EPIDURAL INJECTION OF AIR BROCKUTNE, J., PROPST, J., JAFFE, R., SCHNITTGER, BALSON, SIEGEL, L. LIPPINCOTT-RAVEN PUBL. 1993: A879

  View details for Web of Science ID A1993LY10800878

• REMEMBER THE GUM-ELASTIC BOUGIE AT EXTUBATION JOURNAL OF CLINICAL ANESTHESIA Robles, B., Hester, J., BROCKUTNE, J. G. 1993; 5 (4): 329-331

  Abstract

  Although the use of a gum-elastic bougie to secure an airway is well described, its use during extubation is not well documented. A bougie was passed through the endotracheal tube (ETT) prior to extubation in anticipation of possible reintubation of a patient with a difficult airway. Once the bougie was in place, the ETT was removed over it. Later, when the patient's airway did become compromised, the trachea was rapidly reintubated using the bougie, without the need for direct laryngoscopy, fiberoptic bronchoscopy, or, worse, emergency tracheostomy.

  View details for Web of Science ID A1993LR75700017

  View details for PubMedID 8373614

• ARE ELECTROCARDIOGRAPHIC CHANGES THE 1ST SIGN OF IMPENDING PERIOPERATIVE PNEUMOTHORAX ANAESTHESIA BROCKUTNE, J. G., Botz, G. 1993; 48 (6): 543-544

  View details for Web of Science ID A1993LE08000044

  View details for PubMedID 8323015

• THE EFFECT OF CRICOID PRESSURE ON PREVENTING GASTRIC INSUFFLATION IN INFANTS AND CHILDREN ANESTHESIOLOGY MOYNIHAN, R. J., BROCKUTNE, J. G., ARCHER, J. H., FELD, L. H., KREITZMAN, T. R. 1993; 78 (4): 652-656

  Abstract

  The use of cricoid pressure for the possible prevention of regurgitation of gastric contents during induction of anesthesia in both adults and children has been recommended. However, equally important is the technique in possibly preventing insufflation of gas into the stomach. This study was designed to determine the efficacy of cricoid pressure application in preventing gastric gas insufflation in pediatric patients and to determine the airway pressure at which gas entered the stomach (pop-off point).Fifty-nine patients, 2 weeks to 8 yr of age, physical status 1-4, scheduled for elective surgery, received an inhalational induction of anesthesia with halothane, N2O, and O2. A single observer used a stethoscope to auscultate over the upper abdomen for any air entry. In study I (without paralysis), the proximal airway pressure was slowly increased by gradually closing the pop-off valve on the anesthesia machine until gas was heard entering the stomach (pop-off point) or until the peak inspiratory pressure (PIP) reached 40 cm H2O. Thereafter, the pressurization procedure was repeated three times, altering the application and removal of cricoid pressure. The same patients were then paralyzed (study II), and the stomach evacuated before commencing an identical pressurization sequence with and without cricoid pressure.Appropriately applied cricoid pressure was 100% effective in preventing gas insufflation into the stomach of all children up to 40 cm H2O PIP with and without paralysis. In addition, paralysis significantly decreased the median pop-off point in any given patient.Appropriate application of cricoid pressure prevents gastric gas insufflation during airway management via mask up to 40 cm H2O PIP in infants and children. An additional benefit of cricoid pressure occurs in paralyzed patients in whom gastric insufflation occurs at lower inflation pressures.

  View details for Web of Science ID A1993KV58900006

  View details for PubMedID 8466065

• DELAYED CUTANEOUS FLUID LEAK FROM THE PUNCTURE HOLE AFTER REMOVAL OF AN EPIDURAL CATHETER ANAESTHESIA Ennis, M., BROCKUTNE, J. G. 1993; 48 (4): 317-318

  Abstract

  A case of a delayed but persistent cutaneous fluid leak from a puncture hole following removal of an epidural catheter is presented. The fluid was subsequently found not to be cerebrospinal but interstitial oedema fluid. This case demonstrates the importance of performing simple investigations on any such fluid before ordering more complex tests.

  View details for Web of Science ID A1993KV71200011

  View details for PubMedID 8494134

• AT RISK FOR ASPIRATION - NEW CRITICAL-VALUES OF VOLUME AND PH ANESTHESIA AND ANALGESIA Rocke, D. A., BROCKUTNE, J. G., Rout, C. C. 1993; 76 (3): 666-666

  View details for Web of Science ID A1993KY04000044

  View details for PubMedID 8452288

• ARE ELECTROCARDIOGRAM CHANGES THE 1ST SIGN OF IMPENDING PERIOPERATIVE PNEUMOTHORAX ANAESTHESIA Botz, G., BROCKUTNE, J. G. 1992; 47 (12): 1057-1059

  Abstract

  A patient in the right lateral position underwent left nephrectomy, after which he was placed supine for insertion of an arteriovenous fistula. All haemodynamic and respiratory values, including peak inspiratory pressure, were within normal limits and unchanged from baseline measurements. However, following the position change we noted that the amplitude of the electrocardiogram complexes were dramatically reduced. Our differential diagnosis included the possibility of a pneumothorax, which was subsequently confirmed by both physical examination and chest X ray. A chest drain was planned to be inserted at the end of the surgery, but 25 min after the electrocardiogram changes were noted, the patient's vital signs suddenly deteriorated. Emergency treatment for pneumothorax was instituted with good effect. The diagnostic use of the electrocardiogram and the treatment of this intra-operative pneumothorax are discussed.

  View details for Web of Science ID A1992KE48400011

  View details for PubMedID 1489031

• PERFORMANCE EVALUATION OF A DRAW-OVER VAPORIZER WITH A NONREBREATHING CIRCUIT DURING SIMULATED ADVERSE CONDITIONS JOURNAL OF CLINICAL ANESTHESIA Ali, K., BROCKUTNE, J. G. 1992; 4 (6): 468-471

  Abstract

  Performance evaluation of a draw-over vaporizer with a nonrebreathing circuit during simulated adverse conditions.Open laboratory study.University hospital laboratory. MATERIALS AND INTERVENTIONS: The output (%) of a temperature-compensated Ohmeda Cyprane PAC (portable anesthesia complete) draw-over vaporizer (Ohmeda, Madison, WI) using isoflurane attached to a nonrebreathing circuit was tested in the laboratory during manual ventilation under normal and simulated adverse conditions. The adverse conditions tested were high ambient temperature and static and dynamic positional variation.The results show that the output bias of the PAC vaporizer has a generally consistent profile as tested, except when placed in the 180 degrees full-inversion or 90 degrees anterior-tilt position. We also conducted trials with the Penlon ventilator (Ohmeda, Abingdon, Oxford, U.K.) attached to the circuit at each of its input ports. Ventilation at one input port produced dangerously high airway pressures (within the circuit), thus supporting the manufacturer's recommendation against the use of this port for positive-pressure ventilation. Using the recommended port, the test lung was seen to inflate and deflate appropriately, but, surprisingly, no vapor output was detected by the agent monitor at any vaporizer setting when using the ventilator at the recommended port.Anesthetists should be aware of the pitfalls and possible problems that may be associated with this type of anesthetic delivery system.

  View details for PubMedID 1457114

• ASPECTS OF MECHANICAL VENTILATION AFFECTING INTERATRIAL SHUNT FLOW DURING GENERAL-ANESTHESIA ANESTHESIA AND ANALGESIA Jaffe, R. A., Pinto, F. J., Schnittger, I., Siegel, L. C., Wranne, B., BROCKUTNE, J. G. 1992; 75 (4): 484-488

  Abstract

  Intraoperative transesophageal echocardiography was used to study the incidence of flow-patent foramen ovale in 33 normal, healthy patients (ASA physical status I) undergoing general anesthesia in the supine position for nonthoracic surgical procedures. Echocardiographic contrast was injected intravenously during mechanical ventilation in the presence of 0, 5, 10, 15, or 19 cm H2O positive end-expiratory pressure (PEEP). A final test was performed during the release of 19 cm H2O PEEP. The presence of a flow-patent foramen ovale was detected when the injected echo targets were observed crossing the interatrial septum from right to left. Most interesting, 3 of 33 patients developed a right-to-left shunt that was first detected with the steady application of 10 (1 patient) or 15 cm H2O PEEP (2 patients). In all three cases, the shunt flow was accentuated on the release of PEEP; however, no additional cases were detected using this respiratory maneuver. These cases represent the first demonstration of right-to-left interatrial shunting evoked as the result of the sustained application of PEEP. This study also revealed a lower than expected incidence of flow-patent foramen ovale (9%) when measured during general anesthesia and positive pressure ventilation with or without PEEP.

  View details for Web of Science ID A1992JP53400003

  View details for PubMedID 1530158

• EVALUATION OF A RESPIRATORY RATE MONITOR IN POSTSURGICAL PATIENTS JOURNAL OF CLINICAL ANESTHESIA ANDERSON, W., BROCKUTNE, A. J., BROCKUTNE, J. G., Brodsky, J. B. 1992; 4 (4): 289-291

  Abstract

  To evaluate the clinical use of a cardiorespiratory rate monitor in patients receiving epidural opioids following major surgery.For 6 hours during the night following surgery, patients were continuously monitored with a cardiorespiratory rate monitor and a pulse oximeter, as well as by an in-room observer.Postoperative surgical ward at a university hospital.Eight ASA physical status I and II patients ages 30 to 76 years.Any bradypneic, hypoxemic, bradycardic, or tachycardic event was confirmed by the observer and recorded.The cardiorespiratory rate monitor accurately identified true bradypneic episodes in five of the eight patients. There were no false-positive alarms. The respiratory rate monitor and the pulse oximeter identified one episode of hypoxemia. There were no episodes of bradycardia or tachycardia.The cardiorespiratory rate monitor is useful in patients at risk for bradypnea following surgery.

  View details for Web of Science ID A1992JP81600006

  View details for PubMedID 1384579

• PERIOPERATIVE CORNEAL ABRASIONS ANESTHESIOLOGY BROCKUTNE, J. G., Botz, G., Jaffe, R. A. 1992; 77 (1): 221-221

  View details for Web of Science ID A1992JB53400045

  View details for PubMedID 1610006

• ANESTHESIA IN MILITARY CONFLICTS - TOWARDS SIMPLER, SAFER, AND HIGHER STANDARDS MILITARY MEDICINE BROCKUTNE, J. G. 1992; 157 (5): 229-230

  Abstract

  The increasing military activity in the Persian Gulf necessitates that anesthesiologists in the United States should gain familiarity with the use of a draw-over vaporizer attached to a non-rebreathing circuit. Unfortunately, distributors of draw-over vaporizers in the United States do not allow anesthetists to use this equipment on humans in North America when conventional anesthesia equipment is available. Since the standard of anesthesia care in the U.S. is high, the use of a draw-over vaporizer is not allowed in most settings. Hence, this article reviews the function, the advantages, and disadvantages of a draw-over vaporizer attached to a non-rebreathing circuit. The use of an oxygen concentrator is also discussed, which increases the safety of this anesthetic delivery system.

  View details for Web of Science ID A1992HT31800008

  View details for PubMedID 1630652

• DIFFICULTY IN EXTUBATION - A CAUSE FOR CONCERN ANAESTHESIA BROCKUTNE, J. G., Jaffe, R. A., Robins, B., Ratner, E. 1992; 47 (3): 229-230

  Abstract

  Difficulties in removing the tracheal tube from the trachea are relatively uncommon. We report here a case of difficult extubation which was precipitated by pulling off the pilot balloon and valve assembly in order to deflate the cuff.

  View details for Web of Science ID A1992HH73600012

  View details for PubMedID 1566992

• ASYSTOLE AFTER ANESTHESIA INDUCTION WITH A FENTANYL, PROPOFOL, AND SUCCINYLCHOLINE SEQUENCE ANESTHESIA AND ANALGESIA Egan, T. D., BROCKUTNE, J. G. 1991; 73 (6): 818-820

  View details for Web of Science ID A1991GR64800025

  View details for PubMedID 1952185

• THE EFFECT OF TOURNIQUET RELEASE ON INTRA-COMPARTMENTAL PRESSURE IN THE BANDAGED AND UNBANDAGED LIMB JOURNAL OF HAND SURGERY-BRITISH AND EUROPEAN VOLUME Mars, M., BROCKUTNE, J. G. 1991; 16B (3): 318-322

  Abstract

  Changes in intra-compartmental pressure in bandaged and unbandaged limbs following 90 minutes of tourniquet-induced ischaemia and subsequent tourniquet release are examined in a primate model. Bandaging raises intra-compartmental pressure. Release of the tourniquet is shown to cause a transient increase in intra-compartmental pressure of less than 30 minutes duration. This is followed by a fall in intra-compartmental pressure for up to three hours. Tourniquet release and the ensuing hyperaemia does not appear to put the limb at risk of developing a compartment syndrome.

  View details for Web of Science ID A1991GB58600018

• TRACHEAL INTUBATION WITH THE PATIENT IN A SITTING POSITION BRITISH JOURNAL OF ANAESTHESIA BROCKUTNE, J. G., Jaffe, R. A. 1991; 67 (2): 225-226

  View details for Web of Science ID A1991FZ60000022

  View details for PubMedID 1888612

• INTRAOPERATIVE VENTILATOR-INDUCED RIGHT-TO-LEFT INTRACARDIAC SHUNT ANESTHESIOLOGY Jaffe, R. A., Pinto, F. J., Schnittger, I., BROCKUTNE, J. G. 1991; 75 (1): 153-155

  View details for Web of Science ID A1991FU01700027

  View details for PubMedID 2064044

• A HAIRY PROBLEM ANESTHESIA AND ANALGESIA Brodsky, J. B., BROCKUTNE, J. G., Haddow, G. R., AZAR, D. R. 1991; 72 (6): 839-839

  View details for Web of Science ID A1991FN04200024

  View details for PubMedID 2035871

• USE OF AN OXYGEN CONCENTRATOR LINKED TO A DRAW-OVER VAPORIZER (ANESTHESIA DELIVERY SYSTEM FOR UNDERDEVELOPED NATIONS) ANESTHESIA AND ANALGESIA Jarvis, D. A., BROCKUTNE, J. G. 1991; 72 (6): 805-810

  Abstract

  The use of an oxygen concentrator linked to a draw-over vaporizer was examined. The fractional oxygen concentration from this equipment was dependent on the minute ventilation, oxygen output of the concentrator (%), and the presence of an oxygen economizer tube (OET) (a 900-mL corrugated tube). Fractional oxygen concentrations were always higher with an OET than without an OET (other variables being constant). With the OET in place, the fractional oxygen concentration was only dependent on the minute volume and independent of the pattern of ventilation (i.e., varying inspiratory and expiratory ratios and inspiratory and expiratory pauses). Without an OET, the performance of the system was considerably impaired. In this setting, the final oxygen concentration depended not only on the added flow of oxygen and minute volume but also on the pattern of ventilation. In conclusion, when using a draw-over vaporizer linked to an oxygen concentrator, an OET is essential so as to provide consistent oxygen concentrations to the patient at any given minute volume.

  View details for Web of Science ID A1991FN04200016

  View details for PubMedID 2035865

• DIFFICULT LARYNGOSCOPY MASKED BY PREVIOUS COSMETIC SURGERY PLASTIC AND RECONSTRUCTIVE SURGERY BROCKUTNE, J. G., Brodsky, J. B., Haddow, G. R., AZAR, D. R., Kaye, B. 1991; 87 (6): 1143-1144

  View details for Web of Science ID A1991FP12600029

  View details for PubMedID 2034742

• A simple underwater seal apparatus for use in emergencies. Journal of cardiothoracic and vascular anesthesia Brock-Utne, J. G., Brodsky, J. B., Haddow, G., Mark, J. B. 1991; 5 (2): 195-197

  View details for PubMedID 1863736

• MECHANICAL CHIN SUPPORT DURING RADIOTHERAPY ANESTHESIOLOGY BROCKUTNE, J. G., Haddow, G. 1991; 74 (2): 381-381

  View details for Web of Science ID A1991EV64500032

  View details for PubMedID 1990918

• End-tidal CO2 monitoring for patients receiving epidural opiates. Journal of cardiothoracic and vascular anesthesia Brodsky, J., Brock-Utne, J. G. 1991; 5 (1): 102-103

  View details for PubMedID 1907867

• OXYGEN PIPELINE SUPPLY FAILURE - A COPING STRATEGY JOURNAL OF CLINICAL MONITORING Anderson, W. R., BROCKUTNE, J. G. 1991; 7 (1): 39-41

  Abstract

  Oxygen is the most vital drug administered during anesthesia. The delivery of hypoxic or even anoxic gas mixtures during anesthesia has been reported. Because such occurrences often meet with disaster, modern anesthesia machines have a system of alarms to warn against the delivery of hypoxic or anoxic gas mixtures and also to warn of the failure of the oxygen pipeline supply. We describe the occurrence of a sudden failure of the oxygen pipeline supply, and discuss a strategy for coping with this emergency.

  View details for Web of Science ID A1991ET05400007

  View details for PubMedID 1999697

• ANTI-LPS ANTIBODIES REDUCE ENDOTOXEMIA IN WHOLE-BODY CO-60 IRRADIATED PRIMATES - A PRELIMINARY-REPORT AVIATION SPACE AND ENVIRONMENTAL MEDICINE Wells, M. T., Gaffin, S. L., WESSELS, B. C., BROCKUTNE, J. G., Jordaan, J. P., VANDENENDE, J. 1990; 61 (9): 802-806

  Abstract

  Long periods in space may expose astronauts to the potentially harmful effects of ionizing radiation. We have used a primate model to evaluate any role of lipopolysaccharide (LPS, endotoxin) in radiation sickness. Vervet monkeys, which had been whole-body 60Co irradiated with an LD100 exposure, had periodic blood samples taken for the determination of LPS, anti-LPS IgG antibodies and bacteriological studies. On day 2 post-irradiation, primates were treated i.m. with either sterile 0.9% saline, or equine anti-LPS hyperimmune plasma (Anti-LPS), or orally with tripotassium-dicitrato-bismuthate ("Denol"). Gram positive bacteria were evident in blood samples of all animals as early as 2 d post-irradiation. Gram negative bacteria were found in the blood of saline- and Denol-treated primates by days 5 and 8, respectively, but first appeared on day 13 in the anti-LPS-treated animals. The saline controls and Denol-treated animals showed insignificant rises in plasma LPS on day 3, which increased further thereafter achieving significance on day 8 (p less than 0.01). These elevated levels persisted until death. However, in anti-LPS-treated monkeys, LPS concentrations remained below baseline until day 9, after which they rose significantly until death, but, were significantly less than the concentrations in both other groups (p less than 0.001). The anti-LPS-treated animals survived significantly longer than both the other groups (p less than 0.005). Since LPS may cause nausea, vomiting, diarrhea, anorexia and headaches, Anti-LPS administration may be of value in reducing plasma LPS concentration in humans and improving their performance and survivability.

  View details for Web of Science ID A1990DW85600003

  View details for PubMedID 2241744

• CRITICAL VOLUME FOR PULMONARY ACID ASPIRATION - REAPPRAISAL IN A PRIMATE MODEL BRITISH JOURNAL OF ANAESTHESIA Raidoo, D. M., Rocke, D. A., BROCKUTNE, J. G., Marszalek, A., ENGELBRECHT, H. E. 1990; 65 (2): 248-250

  Abstract

  We have studied, in the monkey, the critical volume for the production of severe pneumonitis following pulmonary aspiration of gastric contents. Aspiration of 0.4 ml kg-1 and 0.6 ml kg-1 at pH1 produced mild to moderate clinical and radiological changes, but no deaths. Aspiration of 0.8 ml kg-1 and 1.0 ml kg-1 at pH1 was associated with an increasingly severe pneumonitis. At 1.0 ml kg-1, 50% of the animals died--a mortality rate considerably less than that reported previously in animal studies. If these results were to be extrapolated to humans, the critical volume for severe aspiration could be increased from 25 ml to 50 ml (0.8 ml kg-1), considerably reducing the percentage of patients perceived to be "at risk".

  View details for Web of Science ID A1990DT20200020

  View details for PubMedID 2223347

• Serum and tissue concentrations of intravenous ceftriaxone during aortic surgery. South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie Robbs, J. V., SALISBURY, R. T., ELSON, K. I., Brock-Utne, J. G. 1989: 11-12

  View details for PubMedID 2799564

• MEASUREMENT OF CEFOXITIN LEVELS IN TISSUE USING HIGH-PRESSURE LIQUID-CHROMATOGRAPHY SOUTH AFRICAN MEDICAL JOURNAL Robbs, J. V., SALISBURY, R. T., ELSON, K. I., BROCKUTNE, J. G. 1989; 75 (9): 420-421

  Abstract

  A high-pressure liquid chromatography (HPLC) method that successfully measured cefoxitin (a modification of the antibiotic cephamycin C) levels in subcutaneous tissue, muscle, and aortic and peripheral arterial walls has been developed. Samples were obtained from 11 patients submitted to prosthetic aortic replacement. All patients received an intravenous bolus dose of cefoxitin 2 g just before induction of anaesthesia. Blood and tissue samples were taken at various intervals intra-operatively. The tissue samples were mechanically homogenised. Both plasma and the tissue homogenates were deproteinated with trichloracetic acid. The cefoxitin was separated by HPLC and measured by ultraviolet absorbance. The results show that the tissue concentration of the drug fell over a 4-hour period and that all levels exceeded the MIC90 (minimum inhibitory concentration that inhibits growth of bacteria at the 90% level) for most aerobic and anaerobic pathogens for at least 3 hours.

  View details for Web of Science ID A1989U611800009

  View details for PubMedID 2524115

• PROPHYLACTIC PARENTERAL CEFUROXIME - SUBCUTANEOUS CONCENTRATIONS IN LAPAROTOMY WOUNDS JOURNAL OF HOSPITAL INFECTION Huizinga, W. K., Hirshberg, A., Thomson, S. R., ELSON, K. I., SALISBURY, R. T., BROCKUTNE, J. G. 1989; 13 (4): 395-398

  Abstract

  Plasma and subcutaneous adipose tissue cefuroxime concentrations were measured in laparotomy wounds, by means of high-pressure liquid chromatography, in 12 patients undergoing elective abdominal operations. After intravenous administration of 1.5 g cefuroxime at induction of anaesthesia, the measured concentrations in serum and wound tissue during a 2 h period were above the MIC 90 of most micro-organisms derived from the alimentary tract. Tissue peak levels were reached within 15 min and the tissue half life was 1.5 h.

  View details for Web of Science ID A1989U955200008

  View details for PubMedID 2567770

• MAJOR THORACIC INCISIONAL INJURY - VENTILATORY MANAGEMENT ANESTHESIA AND ANALGESIA Naicker, S., BROCKUTNE, J. G., Aitchison, J. 1989; 68 (5): 702-702

  View details for Web of Science ID A1989U462300032

  View details for PubMedID 2719303

• INFLUENCE OF PREOPERATIVE GASTRIC ASPIRATION ON THE VOLUME AND PH OF GASTRIC CONTENTS IN OBSTETRIC PATIENTS UNDERGOING CESAREAN-SECTION BRITISH JOURNAL OF ANAESTHESIA BROCKUTNE, J. G., Rout, C., Moodley, J., MAYAT, N. 1989; 62 (4): 397-401

  Abstract

  Aspiration of gastric contents, the most common anaesthetic cause of maternal mortality, is decreased by emptying of the stomach and the use of antacids and H2-receptor antagonists. One hundred and eighty-three mothers presenting for emergency Cesarean section were allocated to three groups. In group 1, the stomach was emptied before operation via an orogastric tube and thereafter 30 ml of sodium citrate 0.3 mol litre-1 was ingested 5-15 min before induction of general anaesthesia (our usual practice). Group 2 received only 30 ml of sodium citrate 0.3 mol litre-1. Group 3 received ranitidine 50 mg i.v. before operation, 5-15 min before induction of anaesthesia, in addition to sodium citrate. Our results show that preoperative gastric emptying with an orogastric tube followed by sodium citrate is preferred if anaesthesia should be induced 15-20 min later. However, the use of ranitidine and sodium citrate is preferred at subsequent times. Although our data show that preoperative gastric emptying decreased the mean intragastric volumes before Caesarean section, the number of patients at risk of acid aspiration was not reduced. In view of these findings and the unpleasantness of orogastric intubation, we suggest that routine preoperative gastric aspiration via an orogastric tube is not justified, although the manoeuvre should still be used following a recent meal.

  View details for Web of Science ID A1989U175300010

  View details for PubMedID 2706175

• CHANGES IN LIPOPOLYSACCHARIDE CONCENTRATIONS IN HEPATIC PORTAL AND SYSTEMIC ARTERIAL PLASMA DURING INTESTINAL ISCHEMIA IN MONKEYS CIRCULATORY SHOCK Gathiram, P., Wells, M. T., Raidoo, D., BROCKUTNE, J. G., Gaffin, S. L. 1989; 27 (2): 103-109

  Abstract

  The time course of changes in the level of plasma lipopolysaccharides (LPS) in both the hepatic portal and the systemic arterial circulations, together with changes in cardiovascular parameters, was ascertained during a 1 hr occlusion of the superior mesenteric artery (SMA) in six primates. The LPS concentrations before occlusion of the SMA in the hepatic portal and systemic arterial circulation were 0.051 +/- 0.009 and 0.065 +/- 0.011 ng/ml, respectively (NS). At the end of the occlusion period, there was no significant increase in either the hepatic portal or systemic arterial plasma LPS concentrations. Immediately on removal of the occlusion, however, the LPS concentration in the portal plasma increased and peaked at 0.431 +/- 0.124 ng/ml (P less than 0.01) within 17.5 +/- 1.71 min, whereas in the systemic arterial circulation the LPS concentration began to rise but only after a delay of approximately 10 min to peak at 0.287 +/- 0.126 ng/ml (P less than 0.05) within 32.5 +/- 4.23 min of reperfusion. The mean arterial pressure (MAP) declined during the reperfusion period from 98.6 +/- 6.89 to 65.0 +/- 9.5 mm Hg (P less than 0.05). The heart rate showed a small but not significant increase (P greater than 0.2) after about 80 min of reperfusion. These data indicate that the gut is the source of the increased plasma LPS concentration following occlusion of the SMA.

  View details for Web of Science ID A1989T168300002

  View details for PubMedID 2706749

• ENDOTOXINS AND ANTI-ENDOTOXINS (THEIR RELEVANCE TO THE ANESTHETIST AND THE INTENSIVE-CARE SPECIALIST) ANAESTHESIA AND INTENSIVE CARE BROCKUTNE, J. G., Gaffin, S. L. 1989; 17 (1): 49-55

  Abstract

  Endotoxins (lipopolysaccharides, LPS) are potent bacterial poisons always present within the intestines in considerable amounts. Several pathophysiological conditions such as hypovolaemia, hypoxia, intestinal ischaemia, burns and radiation lead to a breakdown in the barrier and depending upon the extent of the injury, endotoxins enter the systemic circulation in increasing amounts. Antibiotics do not inactivate the endotoxins which continue to exert their toxic effects leading to nausea, vomiting, diarrhoea, fever, disseminated intravascular coagulation, vascular collapse and organ failure. When nonabsorbable antibiotics are given prior to the insult, systemic endotoxaemia is prevented. Immunotherapy, using anti-lipopolysaccharide IgG, inactivates plasma endotoxins, destroys gram-negative bacteria and opsonises them and may become a major form of therapy. An outline of endotoxin and anti-lipopolysaccharide and its importance to the anaesthetist and intensive care specialist is presented.

  View details for Web of Science ID A1989T251600012

  View details for PubMedID 2653093

• GENERALIZED CONVULSIONS FOLLOWING REGIONAL ANESTHESIA - A PERTINENT LESSON ANESTHESIA AND ANALGESIA Naidu, R., BROCKUTNE, J. G. 1988; 67 (12): 1192-1193

  View details for Web of Science ID A1988R524200017

  View details for PubMedID 3195738

• ACID ASPIRATION IN PRIMATES (A SURPRISING EXPERIMENTAL RESULT) ANAESTHESIA AND INTENSIVE CARE Raidoo, D. M., Marszalek, A., BROCKUTNE, J. G. 1988; 16 (3): 375-376

  View details for Web of Science ID A1988Q620700025

  View details for PubMedID 3189749

• ORAL ADMINISTERED NONABSORBABLE ANTIBIOTICS PREVENT ENDOTOXEMIA IN PRIMATES FOLLOWING INTESTINAL ISCHEMIA JOURNAL OF SURGICAL RESEARCH Gathiram, P., Wells, M. T., BROCKUTNE, J. G., WESSELS, B. C., Gaffin, S. L. 1988; 45 (2): 187-193

  Abstract

  Plasma lipopolysaccharide (LPS) concentrations have been found to increase during a temporary occlusion of the superior mesenteric artery (SMA). We have attempted to show, by a prophylactic oral administration of a nonabsorbable antibiotic to monkeys subjected to an SMA occlusion shock, that the increased LPS is intestinal in origin. A total of eight monkeys were subjected to a temporary occlusion of the SMA. Four monkeys received prophylactic oral administration of a nonabsorbable antibiotic, while the rest acted as controls. The plasma LPS concentrations before occlusion in the control and the kanamycin group were 0.069 +/- 0.006 and 0.092 +/- 0.005 ng/ml, respectively. At the end of the 1-hr occlusion period the plasma LPS concentration in the controls increased to 0.09 +/- 0.009 ng/ml (P less than 0.1) and peaked to 0.378 +/- 0.103 ng/ml (P less than .001) within 20 min of reperfusion. Thereafter, the plasma LPS concentration returned slowly to baseline. In the kanamycin group the plasma LPS concentration remained at baseline throughout both the occlusion and reperfusion periods. These data suggest that the origin of the increased plasma LPS concentration seen following temporary occlusion of the SMA is from the gut, and is information of possible importance in patients about to undergo intestinal surgery.

  View details for Web of Science ID A1988P625700005

  View details for PubMedID 3043108

• PORTAL AND SYSTEMIC PLASMA LIPOPOLYSACCHARIDE CONCENTRATIONS IN HEAT-STRESSED PRIMATES CIRCULATORY SHOCK Gathiram, P., Wells, M. T., Raidoo, D., BROCKUTNE, J. G., Gaffin, S. L. 1988; 25 (3): 223-230

  Abstract

  Lipopolysaccharide (LPS) concentrations in hepatic portal and systemic arterial plasma were determined in five anesthetised monkeys heat-stressed by an environmental temperature of 41.0 +/- 0.3 degrees C and 100% relative humidity. As the rectal temperature (Tr) rose, the LPS concentrations in both the portal and systemic arterial plasma remained at the pre-heat-stress levels of 0.088 +/- 0.017 and 0.078 +/- 0.021 ng/ml (N.S.), respectively, until a Tr of 42.5-43.0 degrees C, when the LPS concentration increased slowly, first in the portal plasma and then in the systemic plasma. On the other hand, the concentration of plasma anti-LPS IgG antibodies began to decline at temperatures as low as 40 degrees C from 20.66 +/- 7.35 micrograms/ml (portal) and 22.14 +/- 7.43 micrograms/ml (arterial) to 5.51 +/- 1.28 micrograms/ml (portal) (P less than .05) and 4.6 +/- 1.69 micrograms/ml (arterial) (P less than .05) just prior to death. Above a Tr of 43 degrees C, the LPS concentration increased rapidly to a maximum of 0.244 +/- 0.05 ng/ml (portal) (P less than .01) and 0.224 +/- 0.06 ng/ml (arterial) (P less than .01). The mean arterial pressure remained more or less constant at 112 +/- 17.03 mm Hg until a Tr of 41.5 degrees C and then rapidly declined as Tr rose (P less than .01). The heart rate rose gradually from 154 +/- 14 min-1 as Tr increased and then rapidly after a Tr of 41.5 degrees C to a maximum of 307 +/- 13 min-1 at 43.0 degrees C. Thereafter it declined rapidly until death.(ABSTRACT TRUNCATED AT 250 WORDS)

  View details for Web of Science ID A1988P259700009

  View details for PubMedID 3168172

• STRENUOUS EXERCISE CAUSES SYSTEMIC ENDOTOXEMIA JOURNAL OF APPLIED PHYSIOLOGY Bosenberg, A. T., BROCKUTNE, J. G., Gaffin, S. L., WELLS, M. T., BLAKE, G. T. 1988; 65 (1): 106-108

  Abstract

  Eighteen triathletes were studied before and immediately after competing in an ultradistance triathlon. Their mean plasma lipopolysaccharide (LPS) concentrations increased from 0.081 to 0.294 ng/ml (P less than 0.001), and their mean plasma anti-LPS immunoglobulin G (IgG) concentrations decreased from 67.63 to 38.99 micrograms/ml (P less than 0.001). Both pretriathlon plasma LPS and anti-LPS IgG levels were directly related to the intensity of training (P less than 0.02 and P less than 0.01, respectively). It is possible that training-induced stress led to some leakage of LPS into the circulation, which, in turn, resulted in self-immunization against LPS. The effects on athletic performance in relation to exercise-induced changes in plasma LPS and anti-LPS IgG levels require further investigation.

  View details for Web of Science ID A1988P400100016

  View details for PubMedID 3403455

• AN EMERGENCY LARYNGOSCOPE (THAT WORKS) FOR R35 SOUTH AFRICAN MEDICAL JOURNAL Mars, M., BROCKUTNE, J. G. 1988; 73 (12): 738-738

  View details for Web of Science ID A1988N922200032

  View details for PubMedID 3381159

• ENDOTOXAEMIA IN RACEHORSES FOLLOWING EXERTION JOURNAL OF THE SOUTH AFRICAN VETERINARY ASSOCIATION-TYDSKRIF VAN DIE SUID-AFRIKAANSE VETERINERE VERENIGING Baker, B., Gaffin, S. L., Wells, M., WESSELS, B. C., BROCKUTNE, J. G. 1988; 59 (2): 63-66

  Abstract

  Endotoxins (lipopolysaccharides-LPS) and anti-endotoxin IgG antibodies were measured in racehorses before and after races of 1,000, 2,000 and 2,800 m. Results show that the mean plasma concentration of endotoxin increased significantly (p less than 0.02) while the anti-LPS IgG concentration decreased significantly (p less than 0.005) in all horses following the races. Pre-race and post-race anti-LPS IgG levels in racing-fit racehorses were significantly higher than in untrained horses (p less than 0.05). The possibility therefore exists that training-induced stress leads to leakage of LPS into the systemic circulation which results in self-immunisation against LPS. The effects of plasma LPS and anti-LPS IgG concentrations on performance of racehorses require further studies.

  View details for Web of Science ID A1988P389800001

  View details for PubMedID 3392702

• PLASMA ENDOTOXIN CONCENTRATION IN HEALTHY PRIMATES AND DURING ESCHERICHIA-COLI-INDUCED SHOCK CRITICAL CARE MEDICINE WESSELS, B. C., Wells, M. T., Gaffin, S. L., BROCKUTNE, J. G., Gathiram, P., Hinshaw, L. B. 1988; 16 (6): 601-605

  Abstract

  The normal range for circulating plasma endotoxin concentration was determined in 62 healthy primates (vervet monkeys, Cerecopithecus aethiops) by the chromogenic substrate modification of the Limulus amoebocyte lysate test, and found to have a mean of 0.076 +/- 0.004 ng/ml (range 0.000 to 0.0127). Four anesthetized primates received an LD100 iv infusion of Escherichia coli over one hour. Plasma concentrations of endotoxin (lipopolysaccharide, LPS) and anti-LPS IgG, and viable E. coli colonies in circulating whole blood samples were determined at specified intervals. Plasma antiendotoxin IgG concentration was determined by an enzyme-linked immuno-absorbent assay, and viable bacterial counts were assayed by standard plate count techniques. LPS concentration increased during E. coli infusion to a mean of 1.13 +/- 0.068 ng/ml (p less than .001) with a concomitant decrease in the concentration of anti-LPS IgG to 59 +/- 5% of control values (p less than .005). Viable circulating E. coli colonies increased during the infusion to a maximum of 425 X 10(6) cfu/ml 10 min after the completion of the infusion, but fell precipitously 20 min later to 10.1 X 10(6) cfu/ml. When each animal succumbed, their respective plasma LPS concentrations were still raised, whereas no viable circulating E. coli colonies were present at a dilution of 10(2). Elevated plasma LPS could prove to be a significant circulating pathogen during Gram-negative bacterial shock and supports the possible association between plasma LPS and morbidity, and mortality in septic shock.

  View details for Web of Science ID A1988N820900007

  View details for PubMedID 3286118

• ENDOTOXAEMIA IN EXHAUSTED RUNNERS AFTER A LONG-DISTANCE RACE SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., Gaffin, S. L., Wells, M. T., Gathiram, P., Sohar, E., James, M. F., MORRELL, D. F., Norman, R. J. 1988; 73 (9): 533-536

  Abstract

  The extent to which plasma endotoxin concentrations increased was measured in 89 randomly selected exhausted runners who required admission to the medical tent for treatment in the 1986 Comrades Marathon (89,4 km). Eighty-one per cent had concentrations above the upper limit of 0,1 ng/ml ('endotoxaemic'), including 2% above 1 ng/ml (the reported lethal level in humans), and only 19% had normal levels. There was a negative correlation between plasma endotoxin and plasma anti-endotoxin IgG concentration (P less than 0,025). Those runners completing the race in less than 8 hours had a significantly lower average endotoxin value than those taking longer than 8 hours (P less than 0,025). Also 80,6% of runners (58/72) with high plasma endotoxin values reported nausea, vomiting and/or diarrhoea, compared with 17,7% (3/17; P less than 0,001) with low endotoxin values. Elevated plasma endotoxin concentrations of 32 randomly selected endotoxaemic runners had returned to normal 1-3 weeks later, and most of them (25/32) had increased anti-endotoxin IgG concentrations (P less than 0,02). Fifty-nine runners randomly selected in a short run (21,1 km) 3 weeks after the 89,4 km run completed the race without problems and none showed any increase in endotoxin levels. Further studies in this field are warranted, especially the measurement of endotoxin and anti-endotoxin values from commencement of training to full fitness. It is possible that these measurements may prove useful as predictors of an athlete's or combat soldier's performance.

  View details for Web of Science ID A1988N394000013

  View details for PubMedID 3375945

• PROPHYLACTIC CORTICOSTEROID INCREASES SURVIVAL IN EXPERIMENTAL HEAT-STROKE IN PRIMATES AVIATION SPACE AND ENVIRONMENTAL MEDICINE Gathiram, P., Wells, M. T., BROCKUTNE, J. G., Gaffin, S. L. 1988; 59 (4): 352-355

  Abstract

  It has been suggested that endotoxins or lipopolysaccharides (LPS), may contribute to heat stroke pathophysiology. In this study, 11 anesthetised monkeys were divided into 2 groups. The steroid group (n = 5) had received a dose of MPSS (30 mg.kg-1, i.v.) before being heat-stressed and the control animals (n = 6) received saline equivolumetrically. The animals were heat-stressed to a rectal temperature of 43.5 degrees C in an environmental temperature of 41 +/- 0.3 degrees C and 100% relative humidity and then allowed to recover at room temperature. Blood samples for LPS and anti-LPS IgG analyses were taken both before treatment and before and after heat-stress. The administration of prophylactic MPSS increased the survival rate significantly from 33% to 100% (p less than 0.05). The plasma LPS level in the steroid group showed very little change after heat-stress, whereas in the non-surviving controls there was a significant increase in plasma LPS level (from 0.089 +/- 0.007 to 0.257 +/- 0.031 ng.ml-1) (p less than 0.005). The control animals that survived showed very little increase in plasma LPS levels, but had about 300% greater plasma Anti-LPS IgG levels. We conclude that pretreatment with MPSS improves the survival rate during heat stroke, possibly by suppressing the rise in plasma LPS concentration.

  View details for Web of Science ID A1988M930900011

  View details for PubMedID 3285827

• INTRACEREBRAL HEMORRHAGE IN A PRIMATE MODEL - EFFECT ON REGIONAL CEREBRAL BLOOD-FLOW SURGICAL NEUROLOGY Bullock, R., BROCKUTNE, J., VANDELLEN, J., Blake, G. 1988; 29 (2): 101-107

  Abstract

  The dynamic changes in regional cerebral blood flow (rCBF), induced by a developing intracerebral hematoma, were studied in eight anesthetized monkeys. Hematomas were generated by allowing femoral arterial blood to enter the caudate nucleus via a stereotactically implanted needle. Intracranial pressure peaked at 51 +/- 8 mmHg at 3 minutes after the ictus, and remained high throughout the 3-hour procedure. Cerebral blood flow was significantly reduced in all brain regions for 1 hour after the ictus. The lowest rCBF values were recorded in the immediate clot penumbra and were below threshold levels for ischemic neuronal damage for 90 minutes after the hemorrhage.

  View details for Web of Science ID A1988L741800004

  View details for PubMedID 3336844

• PROPHYLACTIC CORTICOSTEROID SUPPRESSES ENDOTOXEMIA IN HEAT-STRESSED PRIMATES AVIATION SPACE AND ENVIRONMENTAL MEDICINE Gathiram, P., Gaffin, S. L., BROCKUTNE, J. G., Wells, M. T. 1988; 59 (2): 142-145

  Abstract

  We previously found that lipopolysaccharides (LPS) leak from the gut lumen into the hepatic portal vein during heat stroke. Furthermore, we found that prophylactic corticosteroid administration could prevent a rise in plasma LPS concentration in superior mesenteric artery occlusion shock. In this study, we found that treatment prior to heat-stress with corticosteroids could prevent any rise in plasma LPS concentration in heat-stressed primates. Two groups of primates, one of which received a prophylactic dose of methylprednisolone sodium succinate (MPSS) (n = 4) were subjected to heat-stress (41 +/- 0.3 degrees C). Their arterial blood pressure, heart rate and rectal temperature (Tr) were continuously recorded. In the untreated control group (n = 8), the plasma LPS concentration tended to increase slowly at a Tr of 41.5 degrees C from an initial 0.06 +/- 0.013 ng.ml-1. Above a Tr of 43 degrees C, the plasma LPS level rose rapidly until at a Tr of 44.4 +/- 0.1 degrees C, the mean LPS level was 0.315 +/- 0.03 ng.ml-1 (p less than 0.001). Prophylactic treatment with MPSS suppressed the increase in plasma LPS levels to 0.066 +/- 0.01 ng.ml-1 before heat-stress and 0.03 +/- 0.01 ng.ml-1 at Tr 44.4 degrees C just before primate demise. The mean arterial pressure of the control group was lower than the treated group for any given Tr; between Tr 42-43 degrees this difference was significant (p less than 0.05). Moreover, the cardiovascular parameters began to deteriorate at a lower Tr in the control group.

  View details for Web of Science ID A1988L981800010

  View details for PubMedID 3278709

• ANTILIPOPOLYSACCHARIDE IMPROVES SURVIVAL IN PRIMATES SUBJECTED TO HEATSTROKE CIRCULATORY SHOCK Gathiram, P., Wells, M. T., BROCKUTNE, J. G., Gaffin, S. L. 1987; 23 (3): 157-164

  Abstract

  Recent investigations have suggested that endotoxins or lipopolysaccharides (LPS) may play a role in heat stroke pathophysiology. In this study we wish to investigate whether prophylactic administration of anti-LPS hyperimmune plasma improves survival of experimental heat stroke in primates. Eleven monkeys were anesthetised and heat-stressed to a rectal temperature of 43.5 degrees C (group A) and then allowed to recover at room temperature. Five had received a prophylactic i.v. dose of equine anti-LPS (experimental group), while the other six (control group) received an equivalent i.v. dose of nonimmune equine plasma. All the experimental monkeys survived, while only one out of the six controls survived (chi 2 = 4.65, p less than 0.025). All the control animals that succumbed had significantly elevated plasma LPS levels (p less than 0.05) as compared to the experimental group and the single surviving control. The latter showed very little or no change in plasma LPS levels. A further eight monkeys (group B) were heat-stressed to a rectal temperature of 43.8 degrees C. Of these eight, four had received a prophylactic i.v. dose of equine anti-LPS plasma. Although all eight animals died, the four which were pretreated with anti-LPS plasma had a significantly longer survival time (427.5 +/- 61.39 min) than the untreated group (81.25 +/- 33.94 min) (p less than 0.05). Furthermore, the plasma LPS levels in the treated monkeys remained unchanged whereas in the untreated group, a significantly elevated plasma LPS level was noticed (p less than 0.005). We conclude that LPS may have a role in heat stroke pathophysiology and that prophylactic treatment with anti-LPS antibodies would seem to offer protection against the effects of heat stress.

  View details for Web of Science ID A1987K717300002

  View details for PubMedID 3427771

• CISTERNAL CEREBROSPINAL-FLUID CONCENTRATIONS OF MORPHINE FOLLOWING INTRATHECAL AND EPIDURAL ADMINISTRATION IN THE BABOON ANAESTHESIA AND INTENSIVE CARE Hampton, W. A., Lavies, N. G., Downing, J. W., BROCKUTNE, J. G., SALISBURY, R. T., ELSON, K. I. 1987; 15 (4): 445-450

  Abstract

  Eleven baboons, anaesthetised with ketamine, had catheters introduced into the cisterna magna. Morphine was injected at lumbar level intrathecally in six and epidurally in five. Cisternal CSF was sampled hourly and the morphine concentration measured using a high pressure liquid chromatograph. In two cases following intrathecal injection peaks of 180 ng/ml at 4 hours, and 2,200 ng/ml at 3 hours were detected. In the latter case there was associated error in sampling therefore this baboon had a repeat injection four weeks later. The maximum level of morphine obtained then was 139 ng/ml at 4 hours. In the epidural group peaks of 113 ng/ml and 53 ng/ml at 1 hour were measured in 2 baboons and 27 ng/ml at 6 hours in a third. In all six other baboons following either procedure no morphine was detected in the cisterna. We conclude that morphine injected either intrathecally or epidurally in primates does migrate centrally in varying quantities. This finding would seem to have some bearing on the unpredictability of reported episodes of respiratory depression following intraspinal morphine.

  View details for Web of Science ID A1987K987300015

  View details for PubMedID 3425884

• TIME COURSE OF ENDOTOXEMIA AND CARDIOVASCULAR CHANGES IN HEAT-STRESSED PRIMATES AVIATION SPACE AND ENVIRONMENTAL MEDICINE Gathiram, P., Gaffin, S. L., BROCKUTNE, J. G., Wells, M. T. 1987; 58 (11): 1071-1074

  Abstract

  Heat stress causes a marked reduction in splanchnic blood flow in order to compensate for the increased flow to the skin. Splanchnic ischemia causes a leakage of endotoxins from the gut lumen into the portal circulation and, especially in the presence of a compromised reticuloendothelial system, may cause severe systemic endotoxemia. Since many of the pathological features of heat stroke are similar to the shock state produced by LPS, we examined whether heat-stress causes endotoxemia. Five anesthetized monkeys were subjected to an environmental temperature of 41 degrees +/- 0.3 degrees C and relative humidity of 100%, until death. Rectal temperatures were recorded continuously, blood pressure and ECG were recorded at 5-min intervals, and arterial blood samples were taken at 15-30 min intervals. A decline in mean arterial pressure and rapid rise in heart rate occurred at about 42 degrees C. Plasma LPS remained at 0.071 +/- 0.006 ng.ml-1 until a rectal temperature of +/- 42 degrees C. Thereafter, it increased slowly until beyond 43 degrees C when it rose rapidly to 0.347 +/- 0.024 prior to death. Endotoxemia may have been a contributing factor in the pathogenesis of heat stroke. If so, then the use of anti-LPS antibodies may be expected to be beneficial.

  View details for Web of Science ID A1987K714900005

  View details for PubMedID 3689271

• PREVENTION OF ENDOTOXEMIA BY NONABSORBABLE ANTIBIOTICS IN HEAT-STRESS JOURNAL OF CLINICAL PATHOLOGY Gathiram, P., Wells, M. T., BROCKUTNE, J. G., WESSELS, B. C., Gaffin, S. L. 1987; 40 (11): 1364-1368

  Abstract

  Four anaesthetised monkeys were given oral kanamycin (15 mg 1 kg 12 hourly) over five consecutive days before being heat stressed. Four other anaesthetised monkeys served as controls. The plasma lipopolysaccharide concentration in control primates increased initially from 0.044 (SEM 0.004) ng/ml to 0.062 (0.006) ng/ml as the rectal temperature increased from 37.5 to 39.5 degrees C. A second increase in lipopolysaccharides started at 42 degrees C and reached 0.308 (0.038) ng/ml (p less than 0.01) at 44.5 degrees C. Before heat stress the plasma lipopolysaccharide concentration in the primates who had been pretreated with kanamycin was 0.007 (0.006) ng/ml, and despite heating these animals to 44.5 degrees C no increase in plasma lipopolysaccharide concentrations were seen in this group. The cardiovascular variable during heat stress were more unstable in the control group and began to deteriorate at a lower temperature than in the group receiving antibiotic. These data suggest that the increased plasma lipopolysaccharide concentration during heat stress originates mainly from the gut.

  View details for Web of Science ID A1987K843700020

  View details for PubMedID 3693572

• THE USE OF GASTROZEPIN AS A PROPHYLAXIS AGAINST PULMONARY ACID ASPIRATION - A NEW MUSCARINIC RECEPTOR ANTAGONIST EUROPEAN JOURNAL OF ANAESTHESIOLOGY CALLANDER, P., Humphrey, D., BROCKUTNE, J. G. 1987; 4 (2): 149-153

  Abstract

  Ninety patients presented for elective surgery and were randomly divided into three groups and studied on a double-blind basis to assess the efficacy of gastrozepin, a new muscarinic receptor antagonist, compared to cimetidine and placebo. Gastrozepin 10 mg, cimetidine 200 mg and a placebo were given i.v. on average 90 min prior to surgery. Gastric fluid was aspirated immediately after induction of anaesthesia and the volume and pH measured. The mean gastric fluid volume in the placebo group (19.73 ml) was significantly (P less than 0.02) greater than the mean volume of either the gastrozepin group (12.40 ml) or cimetidine group (12.72 ml). Mean gastric pH's were 4.83 (gastrozepin), 6.39 (cimetidine) and 3.21 (placebo) and each of these means differed significantly from the other two (P less than 0.001). However, the number of patients who had a gastric juice volume of more than 25 ml and a pH of less than 2.5 in each of the three groups: gastrozepin, cimetidine and placebo, were 1, 0, and 8, respectively.

  View details for Web of Science ID A1987G816200009

  View details for PubMedID 3595575

• SINGLE LEVER HUMPHREY ADE LOW FLOW UNIVERSAL ANESTHETIC BREATHING SYSTEM .2. COMPARISON WITH BAIN SYSTEM IN ANESTHETIZED ADULTS DURING CONTROLLED VENTILATION CANADIAN ANAESTHETISTS SOCIETY JOURNAL Humphrey, D., BROCKUTNE, J. G., Downing, J. W. 1986; 33 (6): 710-718

  Abstract

  A clinical trial involving ten anaesthetized adult patients was conducted during controlled ventilation using the Humphrey A.D.E. system in the Mapleson "E" mode (lever down). With each patient acting as his or her own control, the parallel (non-coaxial) and coaxial versions of the single lever Humphrey A.D.E. system were compared, using capnography, to the Bain system (Mapleson D/E). All three systems behaved similarly with predictable patient normocarbia when a fresh gas flow of 70 ml X kg-1 X min-1 was used. The A.D.E. system has the added advantage that the switch from controlled to spontaneous ventilation (or vice versa) is achieved quickly and simply. Spontaneous, assisted or automatic controlled ventilation could be instituted at any time merely by the appropriate lever position.

  View details for Web of Science ID A1986E701900003

  View details for PubMedID 3096543

• PERSPECTIVE GRAPHICS AS A MEANS OF PORTRAYING THE DISTRIBUTION OF RADIOLABELED LIGANDS IN THE SPINAL-CORD - A PILOT-STUDY USING INTRATHECALLY ADMINISTERED H-3 MORPHINE ANAESTHESIA AND INTENSIVE CARE Gregory, M. A., BROCKUTNE, J. G., Gathiram, P., Bux, S., Brouckaert, C. J. 1986; 14 (4): 426-430

  Abstract

  Tritium-labelled morphine sulphate was injected into the lumbar (L4-5) subarachnoid space of an adult male baboon. Three hours after injection, the animal was sacrificed. Using quantitative light microscopic autoradiographic mapping techniques, contour and perspective diagrams were prepared that described the position of radiolabel and by inference the distribution of morphine binding sites within the spinal cord. High concentrations of 3H was found in the medial regions of laminae I, II (substantia gelatinosa) and III of the dorsal horns. Smaller, but significant levels were seen bilaterally in the spinal anterolateral quadrant. Minimal 3H activity was seen in the remainder of the spinal cord with the lowest level being recorded in the spinal canal. Perspective graphics proved a precise and attractive method for locating the position and quantifying the concentration of radiolabel in baboon spinal cord.

  View details for Web of Science ID A1986E791000016

  View details for PubMedID 3565728

• SINGLE LEVER HUMPHREY ADE LOW FLOW UNIVERSAL ANESTHETIC BREATHING SYSTEM .1. COMPARISON WITH DUAL LEVER ADE, MAGILL AND BAIN SYSTEMS IN ANESTHETIZED SPONTANEOUSLY BREATHING ADULTS CANADIAN ANAESTHETISTS SOCIETY JOURNAL Humphrey, D., BROCKUTNE, J. G., Downing, J. W. 1986; 33 (6): 698-709

  Abstract

  The single lever Humphrey A.D.E. anaesthetic system, in both coaxial and parallel (non-coaxial) forms, has recently been introduced. In principle the system offers efficient "universal" function by combining the advantages of Mapleson A, D and E systems. A within-patient comparison of its function in the Mapleson A mode (lever up) in spontaneously-breathing anaesthetized subjects was made to that of the original two lever A.D.E., the Magill (Mapleson A) and the Bain (Mapleson D) systems. The coaxial and parallel single lever A.D.E. systems functioned identically to each other and to the original two lever A.D.E. system, a mean fresh gas flow (FGF) of 51 ml X kg-1 X min-1 causing minimal rebreathing. Under identical conditions, the mean FGF required to just cause rebreathing increased to a mean of 71 ml X kg-1 X min-1 and 150 ml X kg-1 X min-1 with the Magill and the Bain systems respectively. With the single lever system, the switch to its Mapleson E mode for controlled ventilation involves the selection of the only alternative lever position (lever down) without further adjustment. The function and practical advantages in this E mode are presented in Part II.

  View details for Web of Science ID A1986E701900002

  View details for PubMedID 3096542

• HYPOXIA-INDUCED ENDOTOXEMIA IN PRIMATES - ROLE OF RETICULOENDOTHELIAL SYSTEM FUNCTION AND ANTILIPOPOLYSACCHARIDE PLASMA AVIATION SPACE AND ENVIRONMENTAL MEDICINE Gaffin, S. L., BROCKUTNE, J. G., Zanotti, A., Wells, M. T. 1986; 57 (11): 1044-1049

  Abstract

  Acute hypoxia is known to cause a marked reduction in intestinal and peripheral blood flow, in favor of blood flow to the brain and heart. Complete occlusion of the intestinal circulation is known to damage the gut wall, allowing potentially lethal endotoxins present within the intestines to escape into the circulation. We examined here whether the breathing of a hypoxic gas mixture could lead to sufficient damage of the intestinal wall to cause endotoxemia. Six anesthetized monkeys breathed air for 1 hr, then an hypoxic mixture (FIO2 = 0.13) containing N2O for 1 h and, finally, 100% O2. Plasma endotoxin concentrations were determined by two methods. After approximately 40 min of hypoxia, the plasma endotoxin level rose significantly from 0.39 to 1.60 ng X ml-1 (p less than 0.001) and then subsided to near control levels. Control monkeys breathing air only or 70% N2O in oxygen (FIO2 = 0.3) for 3 h showed no such elevation in plasma endotoxin concentration. We conclude that hypoxia leads to a temporary endotoxemia in primates. Reticuloendothelial system depression by whole body X-irradiation (200 rads) increased both the magnitude and duration of the hypoxia-induced endotoxemia. Prior administration of equine anti-lipopolysaccharide (anti-LPS) hyperimmune plasma greatly reduced the magnitude of the induced endotoxemia. Since endotoxemia may be lethal, the use of anti-LPS as possible prophylaxis should be considered in persons breathing artificial atmospheres or where acute hypoxia may be a danger.

  View details for Web of Science ID A1986E561100004

  View details for PubMedID 3790022

• EFFECT OF CORTICOSTEROID PROPHYLAXIS ON LIPOPOLYSACCHARIDE LEVELS ASSOCIATED WITH INTESTINAL ISCHEMIA IN CATS CRITICAL CARE MEDICINE Gaffin, S. L., Gathiram, P., Wells, M. T., BROCKUTNE, J. G. 1986; 14 (10): 889-891

  Abstract

  Ischemia of the intestines damages the permeability of the intestinal wall, allowing lipopolysaccharide (LPS) (endotoxin) to leak from the gut lumen into the blood circulation, causing shock and death. We measured LPS levels associated with corticosteroid treatment vs. no treatment in cats whose superior mesenteric artery had been occluded for 60 min. In untreated cats, the preocclusion mean plasma LPS concentration remained stable at 0.069 +/- 0.015 ng/ml. Toward the end of the occlusion period, mean plasma LPS rose to 0.239 +/- 0.032 ng/ml (p less than .01). Release of the clamp and reperfusion with oxygenated blood was followed within 20 min by a large rise in plasma LPS concentration to 0.825 +/- 0.11 ng/ml (p less than .01), which had returned to preocclusion levels about 80 min later. Methylprednisolone (30 mg/kg) was infused into a second group of cats 1.5 h before SMA occlusion. In these cats there was a complete inhibition of the LPS rise both during and after occlusion. These data suggest that the reported beneficial effect of corticosteroids in the treatment of septic shock may be mediated, in part, by reducing LPS leakage from the gut.

  View details for Web of Science ID A1986E333800012

  View details for PubMedID 3757530

• THE LOWER ESOPHAGEAL SPHINCTER AND THE ANESTHETIST SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., Downing, J. W. 1986; 70 (3): 170-171

  Abstract

  Pulmonary aspiration of gastric contents during induction of, or emergence from, anaesthesia poses hazards for both surgical and obstetric patients requiring urgent operations. Little emphasis has been placed on the importance of the lower oesophageal sphincter in relation to regurgitation and aspiration. This is especially important since anaesthetic drugs have been known to both decrease and increase lower oesophageal sphincter (LOS) tone. Any drug that will decrease tone will increase the incidence of gastric oesophageal reflux while drugs that increase tone may decrease this hazard. This review outlines the problem of acid aspiration in relation to the LOS and the various drugs which may influence LOS pressure.

  View details for Web of Science ID A1986D544000019

  View details for PubMedID 3738646

• SUPERIOR MESENTERIC-ARTERY OCCLUSION SHOCK IN CATS - MODIFICATION OF THE ENDOTOXEMIA BY ANTILIPOPOLYSACCHARIDE ANTIBODIES (ANTI-LPS) CIRCULATORY SHOCK Gathiram, P., Gaffin, S. L., Wells, M. T., BROCKUTNE, J. G. 1986; 19 (2): 231-237

  Abstract

  We measured the time course of elevated plasma LPS concentration caused by a temporary intestinal ischemia using the superior mesenteric artery (SMA) occlusion shock model in anesthetized cats. The systemic plasma LPS increased from 0.075 +/- 0.006 ng/cc to 0.219 +/- 0.026 ng/cc (P less than 0.001) during the occlusion period. On release of the clamp, the plasma LPS concentration rose rapidly to 0.716 +/- 0.122 ng/cc (P less than 0.001) within 20 min. Thereafter, it declined to reach baseline levels after 100-120 min reperfusion. A total of 21 animals received IV 1.0 cc/kg antilipopolysaccharide hyperimmune equine plasma (anti-LPS) either 1.5 hr before the occlusion or at 0, 10, or 20 min after release of the occlusion. Prophylactic anti-LPS prevented any rise in plasma LPS both during and after release of the occlusion. The administration of anti-LPS during the reperfusion period completely reversed the endotoxemia caused by intestinal ischemia within 5-10 min. This rapidity of response to anti-LPS may be important in the previously reported therapeutic benefit of anti-LPS.

  View details for Web of Science ID A1986C599500010

  View details for PubMedID 3719923

• EFFICACY OF THE ANTICANCER AGENT CISPLATIN IN THE TREATMENT OF HUMAN CERVICAL SQUAMOUS CARCINOMA XENOGRAFTED IN NUDE-MICE CHEMOTHERAPY PILLAY, C. V., GREENTHOMPSON, R., BROCKUTNE, J. G. 1986; 32 (4): 356-363

  Abstract

  Two human squamous carcinomas of the cervix, established by serial passage in nude mice, are described. The response of the tumours to cis-diamminedichloroplatinum (CDDP) was assessed by comparing tumour weights and by histological observations. Tumours treated with CDDP 10 mg/kg/week for 2 weeks regressed significantly and microscopy revealed extensive degeneration. Treatment with CDDP 5 mg/kg/week produced tumour growth retardation and microscopy showed some degenerative changes, however, viable cells, many of which were mitotic, were evident. There was, therefore, a dose-response relationship. The sensitivity of the tumours to CDDP lends support to its use in humans with this malignancy.

  View details for Web of Science ID A1986D087400007

  View details for PubMedID 3731921

• INDOPROFEN - A NEW NONOPIOID ANALGESIC - A COMPARISON WITH PETHIDINE SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., Love, A. J., MANKOWITZ, E., Downing, J. W. 1985; 68 (11): 803-804

  Abstract

  Indoprofen (400 mg), a non-opioid, non-steroidal anti-inflammatory drug, was compared on a random, double-blind basis with pethidine (1,5 mg/kg) after elective caesarean section (40 patients) and after orthopaedic surgery (40 patients). The drugs were given intravenously during anaesthesia and provided adequate analgesia for a period of up to 2 hours postoperatively. No significant differences between the two drugs were noted in terms of efficacy and side-effects.

  View details for Web of Science ID A1985A024100026

  View details for PubMedID 3906942

• INDOPROFEN, A NONSTEROIDAL ANTIINFLAMMATORY ANALGESIC WHICH DOES NOT DEPRESS RESPIRATION IN NORMAL MAN - A STUDY COMPARING INDOPROFEN WITH MORPHINE SOUTH AFRICAN MEDICAL JOURNAL Love, A. J., RIPLEY, S. H., BROCKUTNE, J. G., BLAKE, G. T. 1985; 68 (11): 801-802

  Abstract

  The respiratory effects of intravenous indoprofen 400 mg, a highly effective non-steroidal anti-inflammatory analgesic, were compared with those of morphine 10 mg in 10 healthy volunteers. Morphine exhibited its characteristic adverse respiratory depressant properties, Indoprofen, in contrast, did not influence the subjects' breathing pattern.

  View details for Web of Science ID A1985A024100025

  View details for PubMedID 3934769

• MORPHINE CONCENTRATION IN BRAIN AND SPINAL-CORD AFTER SUBARACHNOID MORPHINE INJECTION IN BABOONS ANESTHESIA AND ANALGESIA Gregory, M. A., BROCKUTNE, J. G., Bux, S., Downing, J. W. 1985; 64 (9): 929-932

  Abstract

  Tritium-labeled morphine was injected into the lumbar (L4-5) subarachnoid space of three baboons. The animals were sacrificed 3, 6, and 24 hr thereafter. Morphine concentrations were measured at five predetermined positions within the spinal cord, medulla oblongata, and frontal lobes of the brain by scintillation-count assay. The results revealed that morphine ascends in the subarachnoid space and is absorbed into the spinal cord and medulla oblongata in a time-dependent fashion. Ventilation was most depressed and maximal concentrations of morphine were detected in the medulla six hours after injection. Delayed respiratory depression, occasionally reported after intraspinal morphine injection, may therefore be caused as a result of the affinity of morphine for binding sites, possibly opiate receptors, situated within the vital respiratory and cardiovascular neuronal complexes of the medulla.

  View details for Web of Science ID A1985AQB2400013

  View details for PubMedID 3839637

• SEPTICEMIC LOW-BIRTH-WEIGHT NEONATES TREATED WITH HUMAN-ANTIBODIES TO ENDOTOXIN ARCHIVES OF DISEASE IN CHILDHOOD Adhikari, M., Coovadia, H. M., Gaffin, S. L., BROCKUTNE, J. G., MARIVATE, M., Pudifin, D. J. 1985; 60 (4): 382-384

  Abstract

  In a double blind controlled study antilipopolysaccharide gammaglobulin given intramuscularly did not reduce mortality in low birthweight babies suffering from septicaemia. It did, however, reduce the recovery period of survivors from 310 to 120 hours.

  View details for Web of Science ID A1985AGV4900024

  View details for PubMedID 3890768

• A COMPARISON OF NALBUPHINE AND PETHIDINE FOR POSTOPERATIVE PAIN RELIEF AFTER ORTHOPEDIC-SURGERY SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., Ritchie, P., Downing, J. W. 1985; 68 (6): 391-393

  Abstract

  Nalbuphine hydrochloride (Nubain; Du Pont Pharmaceuticals), a synthetic agonist-antagonist analgesic, in a dose of 20 mg was compared with pethidine 100 mg in 60 patients after elective surgery in a random double-blind study. Both drugs were given intramuscularly on the first day after surgery. The pain intensity and visual analogue scales would seem to indicate that nalbuphine has a longer duration of action than pethidine (P less than 0,05). The respiration rates in the pethidine group were significantly more depressed 30 minutes after the injection than in the nalbuphine group (P less than 0,05). Nalbuphine caused less depression of both systolic and diastolic blood pressure at both 30 and 60 minutes (P less than 0,001). The results of the study show that nalbuphine, in the dose used here, may prove to be a useful substitute for pethidine.

  View details for Web of Science ID A1985AQV6500024

  View details for PubMedID 3898418

• EFFECT OF RANITIDINE GIVEN BEFORE ATROPINE SULFATE ON LOWER ESOPHAGEAL SPHINCTER TONE ANAESTHESIA AND INTENSIVE CARE BROCKUTNE, J. G., Downing, J. W., Humphrey, D. 1984; 12 (2): 140-142

  Abstract

  The effects on lower oesophageal sphincter tone of intravenous ranitidine 150 mg followed by atropine 0.6 mg were studied in six healthy volunteers. Ranitidine increased the mean lower oesophageal sphincter pressure by 21.2 cm H2O (p less than 0.01). Subsequent injection of atropine lowered the lower oesophageal sphincter pressure but not significantly, mean sphincter pressure remaining 14.2 cm H2O above control. Barrier pressure to reflux (lower oesophageal sphincter pressure minus gastric pressure) increased significantly after intravenous ranitidine injection, and although it fell after intravenous atropine it was still above control levels. The results of this study suggest that ranitidine increases lower oesophageal sphincter tone. When it is given prior to atropine injection within 20 minutes before induction of anaesthesia it counteracts the deleterious effect of the latter on sphincter tone and barrier pressure to reflux.

  View details for Web of Science ID A1984SS02700011

  View details for PubMedID 6089604

• TOTAL PARENTERAL-NUTRITION WITH THE 3-LITRE BAG - EFFECT OF FAT EMULSION ON AMINO-ACID KINETICS AND NITROGEN-BALANCE IN PATIENTS WITH INTESTINAL FISTULAS CLINICAL NUTRITION OKEEFE, S. J., Ramjee, G., Moldawer, L. L., Haffejee, A. A., BROCKUTNE, J. G. 1984; 38 (5): 375-382

  Abstract

  Three metabolically stable patients, receiving total parenteral nutrition as part of their management for post-surgical intestinal fistulae, were studied over a 16-d period in order to assess the effect of two different energy sources on protein metabolism. Nutrient intake was kept constant throughout except for the energy source: for half the time the patients received glucose alone, for the other half glucose plus fat emulsion (3:1 mixture). Amino acid metabolism, as indicated by rates of leucine turnover, was measured by constant infusion of [1-14C]-leucine for 24 h at the end of each of two 8-d periods. The rates of protein synthesis in the three patients (means of two measurements) were 5.15, 2.45 and 3.8 g/kg/d. No significant difference in nitrogen balance, plasma amino acid concentrations or amino acid kinetic rates could be detected whether energy was supplied as glucose alone or glucose plus fat. The extra expense of supplying energy as fat does not seem justified when total parenteral nutrition is given to stable patients for periods of up to 8 d.

  View details for Web of Science ID A1984AEL6300005

  View details for PubMedID 6439693

• AN EVALUATION OF THE PULSE-CONTOUR METHOD OF MEASURING CARDIAC-OUTPUT SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., BLAKE, G. T., Bosenberg, A. T., Gaffin, S. L., Humphrey, D., Downing, J. W. 1984; 66 (12): 451-453

  Abstract

  The pulse-contour (PC) method continuously derives the cardiac output in litres per minute from the arterial pressure wave form by using a portable analogue computer. The reliability of the PC method in determining cardiac output was studied in 6 patients during anaesthetic induction for cardiac surgery. The results obtained with the PC method using the radial artery to register the arterial pulse wave were compared with cardiac output measurements using the more conventional thermodilution technique. The PC method would seem to offer a simple, clinically useful method for on-line monitoring of short-term variations in cardiac output.

  View details for Web of Science ID A1984TS61500013

  View details for PubMedID 6484771

• TOTAL INTRAVENOUS ANESTHESIA USING LOW-DOSE KETAMINE INFUSION FOR CESAREAN-SECTION - A COMPARISON WITH A STANDARD INHALATION ANESTHETIC TECHNIQUE SOUTH AFRICAN MEDICAL JOURNAL MANKOWITZ, E., Downing, J. W., BROCKUTNE, J. G., MAHARAJ, R. J., MORRELL, D. F. 1984; 65 (7): 246-250

  Abstract

  Anaesthesia was induced in 65 parturients undergoing elective caesarean section with thiopentone 3,5 mg/kg and suxamethonium 1,5 mg/kg intravenously. For anaesthetic maintenance patients were randomly divided into two groups. Patients in group A were ventilated with 50% nitrous oxide in oxygen, supplemented with 0,6-0,8% enflurane and 50 mg pethidine given intravenously after delivery. Group B patients were ventilated with 50% oxygen in nitrogen and received a continuous intravenous infusion of ketamine (70 micrograms/kg/min), with 5 mg diazepam intravenously following delivery. All patients received intravenous alcuronium 0,2 mg/kg. Inspired oxygen concentration (0,5) and end-tidal carbon dioxide tensions (4,0-5,0 kPa), were standardized. Despite a high incidence of predelivery hypotension in group A but not in group B, the fetal acid-base status, materno-placento-fetal exchange and immediate clinical state of the neonates were comparable. Neonatal neurobehavioural assessment scores assessed 2-4 hours after birth favoured the inhalation technique, but this difference disappeared at 24 hours. A higher incidence of factual recall in group B (14,3% v. 7,4%), frequently painful (10,7% v. 0%), the reporting of unpleasant dreams and a lack of significant postoperative analgesia makes the ketamine infusion technique unsatisfactory.

  View details for Web of Science ID A1984SE18400015

  View details for PubMedID 6420904

• TOTAL PARENTERAL-NUTRITION WITH THE 3-LITER BAG - EFFECT OF FAT EMULSION ON AMINO-ACID KINETICS AND NITROGEN-BALANCE IN PATIENTS WITH INTESTINAL FISTULAS HUMAN NUTRITION-CLINICAL NUTRITION OKEEFE, S. J., Ramjee, G., Moldawer, L. L., Haffejee, A. A., BROCKUTNE, J. G. 1984; 38C (5): 375-382

  View details for Web of Science ID A1984TT99900005

• MONITORING NEUROMUSCULAR BLOCKADE - EVALUATION OF A NEW RECTAL ELECTRODE TRANSDUCER SYSTEM IN CATS ANESTHESIA AND ANALGESIA BROCKUTNE, J. G., Adams, B., Downing, J. W. 1984; 63 (2): 152-154

  View details for Web of Science ID A1984SB26300011

  View details for PubMedID 6691580

• CSF PHARMACOKINETICS OF EXTRADURAL MORPHINE BRITISH JOURNAL OF ANAESTHESIA Strube, P. J., Downing, J. W., BROCKUTNE, J. G. 1984; 56 (8): 921-922

  View details for Web of Science ID A1984TE38700018

  View details for PubMedID 6743455

• RECTAL BURN AFTER THE USE OF AN ANAL STAINLESS-STEEL ELECTRODE TRANSDUCER SYSTEM FOR MONITORING MYONEURAL JUNCTION ANESTHESIA AND ANALGESIA BROCKUTNE, J. G., Downing, J. W. 1984; 63 (12): 1141-1142

  View details for Web of Science ID A1984TW82900021

  View details for PubMedID 6507915

• EFFECTS OF ATRACURIUM ON INTRAOCULAR-PRESSURE BRITISH JOURNAL OF ANAESTHESIA MAHARAJ, R. J., Humphrey, D., Kaplan, N., KADWA, H., BLIGNAUT, P., BROCKUTNE, J. G., Welsh, N. 1984; 56 (5): 459-463

  Abstract

  The effects of atracurium on intraocular pressure (IOP) were compared with those of pancuronium in 20 patients less than 45 years-of-age requiring surgery for trauma of one eye. After a standard premedication and the application of topical analgesia to the upper airway, anaesthesia was induced with thiopentone i.v. and the trachea was intubated without the use of neuromuscular blockade. Following 20 min of steady state anaesthesia during which measurements of IOP, arterial pressure, heart rate, FIO2, FE'CO2 and CVP were recorded, one group of patients received atracurium 0.45 mg kg-1 and the other pancuronium 0.1 mg kg-1. The observations were repeated for a further 15 min before surgery commenced. Neither atracurium nor pancuronium produced any change in IOP. Atracurium was associated with greater cardiovascular stability than pancuronium.

  View details for Web of Science ID A1984SV26900005

  View details for PubMedID 6426493

• INTRAVENOUS MIDAZOLAM DOES NOT CHANGE LOWER ESOPHAGEAL SPHINCTER PRESSURE SOUTH AFRICAN MEDICAL JOURNAL Rubin, J., BROCKUTNE, J. G., Downing, J. W. 1983; 64 (26): 1024-1025

  Abstract

  The effect of intravenous midazolam 0.3 mg/kg on lower oesophageal sphincter (LOS) pressure was studied in 8 healthy volunteers. No effect on LOS pressure was noted. The importance of this finding in relation to the possible danger of gastro-oesophageal reflux and pulmonary aspiration of gastric acid content during induction of general anaesthesia is discussed.

  View details for Web of Science ID A1983RV67600014

  View details for PubMedID 6648742

• CIRAMADOL - A NEW SYNTHETIC ANALGESIC - A DOUBLE-BLIND COMPARISON WITH ORAL CODEINE FOR POSTOPERATIVE PAIN RELIEF SOUTH AFRICAN MEDICAL JOURNAL Downing, J. W., BROCKUTNE, J. G., Holloway, A. M. 1983; 64 (25): 978-982

  Abstract

  One hundred and eighty patients (American Society of Anesthesiologists rating 1-2) received one of three oral analgesics--ciramadol (Wy. 15705) 20 mg, ciramadol 60 mg or codeine 60 mg--on a double-blind random basis for the relief of pain 24-48 hours after major general surgical, gynaecological or orthopaedic operations. All three analgesics proved equally effective and caused mild sedation only. No patient showed signs of clinical cardiorespiratory depression, and other side-effects were infrequent. Ciramadol may therefore prove a useful clinical alternative to conventional oral analgesics provided its lack of respiratory depressant properties and addiction potential in monkeys can be substantiated in humans.

  View details for Web of Science ID A1983RV65400016

  View details for PubMedID 6359486

• PROTECTION AGAINST ACID PULMONARY ASPIRATION WITH CIMETIDINE ANAESTHESIA AND INTENSIVE CARE BROCKUTNE, J. G., Downing, J. W., OKEEFE, S. J., GJESSING, J. 1983; 11 (2): 138-140

  Abstract

  Gastric pH values were studied prior to, and up to, ninety minutes after an intravenous injection of cimetidine 200 mg given before general anaesthesia, in twenty surgical patients, all with a gastric pH less than 3.5. At thirty, sixty and ninety minutes, sixteen, eighteen and twenty patients had a gastric pH greater than 3.5 respectively. In conclusion, the results of the present study indicate that cimetidine 200 mg given intravenously 90 minutes before surgery will reduce the hazard of chemical pneumonitis should stomach content be aspirated.

  View details for Web of Science ID A1983QP25400009

  View details for PubMedID 6869777

• TREATMENT OF HYPERTENSION FOLLOWING ENDOTRACHEAL INTUBATION - A STUDY COMPARING THE EFFICACY OF LABETALOL, PRACTOLOL AND PLACEBO SOUTH AFRICAN MEDICAL JOURNAL MAHARAJ, R. J., Thompson, M., BROCKUTNE, J. G., Williamson, R., Downing, J. W. 1983; 63 (18): 691-694

  Abstract

  Labetalol, a new adrenergic receptor antagonist, has both alpha- and beta-blocking properties. Intravenous labetalol (0.25 and 0.5 mg/kg), practolol (0.4 mg/kg) and saline (1 ml), injected prior to anaesthesia, were compared with respect to their effect on the haemodynamic consequences of direct laryngoscopy followed by the passage of an endotracheal tube. When compared with intravenous saline injection, both labetalol and practolol obtunded the tachycardia induced by endotracheal intubation. The higher dose of labetalol was more effective in reducing the hypertensive response than the lower dose of practolol. However, none of the regimens completely abolished the adverse haemodynamic consequences of laryngotracheal manipulations.

  View details for Web of Science ID A1983QP39400014

  View details for PubMedID 6342168

• THE EFFECT OF 50 PERCENT NITROUS-OXIDE IN OXYGEN ON LOWER ESOPHAGEAL SPHINCTER TONE ANAESTHESIA BROCKUTNE, J. G., Downing, J. W. 1983; 38 (4): 383-385

  Abstract

  The effect of 50% nitrous oxide on the lower oesophageal sphincter was studied in eight healthy volunteers. No effect on the sphincter tone was noted in these subjects. The importance of this finding is discussed in relation to the depressant effects of nitrous oxide and other anaesthetic or sedative drugs on the reflex protective mechanisms safeguarding the respiratory tract and lungs from aspiration of acid gastric content and other foreign matter.

  View details for Web of Science ID A1983QJ92700017

  View details for PubMedID 6846768

• TRACE-ELEMENT CONCENTRATIONS IN COMMONLY USED INTRAVENOUS FLUIDS SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., OKEEFE, S. J., Cremer, R., Bosenberg, A. T., GOODWIN, N. M. 1983; 63 (12): 435-436

  Abstract

  The concentrations of several essential trace elements in various intravenous fluids commonly used in South Africa were measured. With the exception of 4% human serum albumin and fresh freeze-dried plasma (FDP), intravenous fluids contained minimal amounts of essential trace elements. Although FDP contained significant quantities of zinc, copper, iron and chromium, the common practice of giving patients on total parenteral nutrition 1-2 units per week will not fulfil the recommended daily requirements. Additional trace element supplements should therefore be given intravenously to these patients.

  View details for Web of Science ID A1983QH02100013

  View details for PubMedID 6836412

• COST OF ANESTHESIA BRITISH MEDICAL JOURNAL Humphrey, D., Downing, J. W., BROCKUTNE, J. G. 1983; 286 (6367): 800-800

  View details for Web of Science ID A1983QE02200032

  View details for PubMedID 6402256

• [The vomiting reflex. Anatomical and physiological aspects]. Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række Brock-Utne, J. G., Gran, L. 1982; 102 (33): 1778-1780

  View details for PubMedID 7167953

• An ELISA procedure for detecting human anti-endotoxin antibodies in serum. Annals of clinical biochemistry Gaffin, S. L., BADSHA, N., Brock-Utne, J. G., Vorster, B. J., Conradie, J. D. 1982; 19 (3): 191-194

  Abstract

  We report an ELISA method suitable for the large-scale screening of blood bank stores to identify those blood units containing high concentrations of antiendotoxin antibodies. In Natal, 8.3% of total units collected had antiendotoxin antibodies at concentrations greater than 40 micrograms/ml, values that may be therapeutically useful. We found that one technician could screen enough samples per year to produce 800 litres of such high-titre plasma.

  View details for PubMedID 7092147

• HEARTBURN IN PREGNANCY BRITISH MEDICAL JOURNAL BROCKUTNE, J. 1982; 285 (6334): 61-61

  View details for Web of Science ID A1982NV64000046

  View details for PubMedID 6805815

• MIDAZOLAM, A NEW INTRAVENOUS INDUCTION AGENT FOR ANESTHESIA SOUTH AFRICAN MEDICAL JOURNAL Holloway, A. M., BROCKUTNE, J. G., SOMMERVILLE, T. E., Pavy, T. J. 1982; 61 (8): 274-276

  Abstract

  In an open non-comparative clinical trial 64 patients older than 18 years with American Society of Anesthesiologists ratings of I and II were studied. Under standardized conditions of premedication, anaesthesia was induced by injecting midazolam (Ro 21-3981) 0,15 or 0,3 mg/kg body weight intravenously. After endotracheal intubation with suxamethonium 1 mg/kg, anaesthesia was maintained with nitrous oxide in oxygen and enflurane or halothane. There were statistically significant cardiovascular changes during and/or after intubation but there were no clinical consequences. Midazolam allows rapid induction of and recovery from anaesthesia. There was no retrograde amnesia and high proportion of the patients assessed the induction of anaesthesia as favourable. The local tolerance was very good. Midazolam seems to be a good alternative for induction of balanced anaesthesia.

  View details for Web of Science ID A1982NC96800012

  View details for PubMedID 7036377

• EPIDURAL KETAMINE - A PRELIMINARY-REPORT SOUTH AFRICAN MEDICAL JOURNAL MANKOWITZ, E., BROCKUTNE, J. G., Cosnett, J. E., GREENTHOMPSON, R. 1982; 61 (12): 441-442

  Abstract

  Ketamine hydrochloride 4 mg in 10 ml 5% dextrose water was administered epidurally to 7 patients suffering from intractable pain in the back, lower abdomen and legs. Pain relief was obtained in all cases. The duration of action varied from half an hour to more than 6 hours. No adverse side-effects were noted and no detectable neurological damage resulted. Intraspinal ketamine offers and advantage over the opiates, in that respiratory depression is unlikely to occur.

  View details for Web of Science ID A1982NG35200020

  View details for PubMedID 7064021

• INTRATHECAL KETAMINE WITH PRESERVATIVE - HISTOLOGICAL EFFECTS ON SPINAL NERVE ROOTS OF BABOONS SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., Kallichurum, S., MANKOWITZ, E., MAHARAJ, R. J., Downing, J. W. 1982; 61 (12): 440-441

  Abstract

  Ketamine, an analgesic-cataleptic drug, provides pain relief without respiratory depression. Ketamine with the preservative benzethonium chloride 0.1 mg/ml was injected intrathecally into 4 baboons under Ketamine anaesthesia. A control group of 2 baboons received intrathecal saline. No assessment as to relief from experimental pain was possible, but all the baboons recovered normally from anaesthesia and were found moving about in their enclosures without gross evidence of neurological impairment. No adverse reactions were noted. One month after the intrathecal injection the baboons were sacrificed, and an autopsy was performed within 30 minutes. No macroscopic abnormally of the cord was noticed. Microscopic examination revealed oedema of a few nerve roots in all animals irrespective of whether ketamine or saline had been injected intrathecally. No other changes attributable to ketamine were seen, and its is therefore concluded that, in the doses given, intrathecally injected ketamine would seem to be safe.

  View details for Web of Science ID A1982NG35200019

  View details for PubMedID 6895952

• MATERNAL MEDICATION DOES TEMPORARILY AFFECT NEONATAL NEUROBEHAVIOR SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., Moosa, A., MANKOWITZ, E., NIESTROJ, B., Downing, J. W. 1982; 62 (26): 985-989

  Abstract

  A modified neurodevelopmental assessment technique, the KEH scale, was applied to 60 healthy newborn infants at 2 - 4 hours of age, and again at 24 hours in order to detect any effect of maternal medication on behaviour. Results show that neonates whose mothers received medication during labour were significantly more depressed at 2 - 4 hours as regarded tone, rooting, reflexes and the total neurobehavioural score than those whose mothers did not receive medication. No difference was found at 24 hours. The Apgar scores were similar at 2 - 4 hours and at 24 hours. The KEH scale detects the subtle effects of maternal medication on the behaviour of newborn infants. It may therefore be of value in assessing the effect of drugs and anaesthetic agents administered to the mother on the neonate. Furthermore, it may prove to be of value in detecting similar effects resulting from prematurity, hypoxia in utero or trauma during delivery.

  View details for Web of Science ID A1982PU98200015

  View details for PubMedID 7147145

• AN ELISA PROCEDURE FOR DETECTING HUMAN ANTI-ENDOTOXIN ANTIBODIES IN SERUM ANNALS OF CLINICAL BIOCHEMISTRY Gaffin, S. L., BADSHA, N., BROCKUTNE, J. G., Vorster, B. J., Conradie, J. D. 1982; 19 (MAY): 191-194

  View details for Web of Science ID A1982NP84700013

• PROTECTION AGAINST PULMONARY ACID ASPIRATION WITH RANITIDINE - A NEW HISTAMINE H2-RECEPTOR ANTAGONIST ANAESTHESIA Andrews, A. D., BROCKUTNE, J. G., Downing, J. W. 1982; 37 (1): 22-25

  Abstract

  Ninety patients presenting for elective surgery were randomly divided into three groups A, B and C and studied on a double-blind basis to assess the effects of ranitidine, a new histamine H2 -receptor antagonist and placebo on gastric secretion. Group A received 150 mg ranitidine orally at 2200 hours on the evening before surgery and a further 150 mg 1-2 hours before operation. Group B received 150 mg ranitidine with premedication only, while Group C received a placebo at 2200 hours and again with premedication on the day of surgery. Gastric fluid was aspirated immediately after induction of anaesthesia and the volume and pH of the aspirate measured. Gastric volumes were significantly greater in the placebo group when compared to Group B, but not to Group A. The proportion of patients with pH greater than 2.5 at induction of anaesthesia was 100, 82.3 and 67.9% in Groups A, B and C, respectively. The percentage of patients who had measured gastric volume less than 25 ml or pH greater than 2.5 were Group A--90%, Group B--75.9% and Group C--57%. Thus ranitidine 150 mg orally on the evening before surgery and on the morning prior to anaesthetic induction lowered the mean volume and raised the average pH of gastric content to safe levels in all cases.

  View details for Web of Science ID A1982NA14400004

  View details for PubMedID 6123277

• ANESTHESIA AND INTRAOCULAR-PRESSURE - A COMPARISON OF TOTAL INTRAVENOUS ANESTHESIA USING ETOMIDATE WITH CONVENTIONAL INHALATION ANESTHESIA ANAESTHESIA Thomson, M. F., BROCKUTNE, J. G., Bean, P., Welsh, N., Downing, J. W. 1982; 37 (7): 758-761

  Abstract

  Intra-ocular pressure (IOP) was measured in two comparable groups of anaesthetised patients under standardised conditions. Group 1 received etomidate 0.3 mg/kg fentanyl 100 micrograms and droperidol 5 mg. with etomidate 20 microgram/kg/minute for maintenance. Group 2 received thiopentone 3.5 mg/kg and were maintained with halothane 0.5% in nitrous oxide (60%) with oxygen. Both groups of patients were ventilated to normocapnia. Blood pressure, heart rate, central venous pressure and IOP were measured in 5 minute intervals from pre-induction to 30 minutes postinduction. A significantly greater reduction in mean IOP (p less than 0.05) occurred in group 1. A maximum fall in IOP of 61% was obtained, compared to a maximum fall of 45% in group 2. Blood pressure fell in both groups. The fall was greater (23%) in group 2 than in group 1 (18%) and in no case was considered excessive. Total intravenous anaesthesia using etomidate is suggested as a useful technique for open eye surgery.

  View details for Web of Science ID A1982NX65900012

  View details for PubMedID 7103023

• HYPERBARIC BUPIVACAINE FOR SPINAL ANALGESIA SOUTH AFRICAN MEDICAL JOURNAL Holloway, A. M., BROCKUTNE, J. G., Downing, J. W. 1982; 61 (9): 314-316

  Abstract

  Sixty-one patients (ASA classification I-III) were studied in an open non-comparative trial to assess the efficacy of hyperbaric bupivacaine for spinal anaesthesia. In 59 patients the quality of analgesic block was good, while 2 required supplementary analgesia and sedation. Four patients became hypotensive, this requiring correction by fluid volume replacement. Hyperbaric bupivacaine, with a mean duration of action of 6 1/2 hours, has proved satisfactory in our anaesthetic practice.

  View details for Web of Science ID A1982ND15200021

  View details for PubMedID 7036379

• EFFECTS OF INTRATHECAL SALINE AND KETAMINE WITH AND WITHOUT PRESERVATIVE ON THE SPINAL NERVE ROOTS OF MONKEYS SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., MANKOWITZ, E., Kallichurum, S., Downing, J. W. 1982; 61 (10): 360-361

  Abstract

  Ketamine, a cataleptic analgesic substance which theoretically may block pain receptors in the spinal cord, providing pain relief without respiratory depression, was injected intrathecally with or without benzethonium chloride 0.1 mg/ml (a preservative) into 8 monkeys under anaesthesia. Two monkeys received saline (control group). No assessment as to relief from experimental pain was possible. All Monkeys recovered normally from anaesthesia and were found moving about in their enclosures without gross evidence of neurological impairment. No adverse reactions were noted. Ten days after the subarachnoid injection the monkeys are sacrificed. Autopsy was performed within 30 minutes. No macroscopic abnormality of the cord was noticed. Microscopic examination revealed oedema of a few nerve roots in all animals, irrespective of whether ketamine or saline was injected intrathecally. Focal degeneration with loss of myelin and axoplasm was observed within a solitary nerve root in 2 monkeys that had received ketamine, 1 with and 1 without preservative. However, in these animals lumbar puncture proved difficult and bloody taps ensued. Hence trauma could have been a contributing factor in these 2 cases. None of the other monkeys showed these changes, regardless of group.

  View details for Web of Science ID A1982NE31200020

  View details for PubMedID 6895951

• MIDAZOLAM FOR THE INTRAVENOUS INDUCTION OF ANESTHESIA IN CHILDREN ANAESTHESIA AND INTENSIVE CARE Holloway, A. M., JORDAAN, D. G., BROCKUTNE, J. G. 1982; 10 (4): 340-343

  Abstract

  Midazolam was compared with thiopentone as an intravenous anaesthetic induction agent in children between four and twelve years of age undergoing elective minor surgical procedures. Successful induction of anaesthesia was achieved in both groups of patients. With midazolam induction time was longer than with thiopentone, but the difference was not statistically significant. The incidence of apnoea was greater with thiopentone, but not significantly so. It is concluded that midazolam is effective and safe, and could prove a reasonable alternative to thiopentone as an intravenous induction agent in children undergoing elective minor operations.

  View details for Web of Science ID A1982PS41100009

  View details for PubMedID 6818871

• FLUNITRAZEPAM INCREASES AND DIAZEPAM DECREASES THE LOWER ESOPHAGEAL SPHINCTER TONE WHEN ADMINISTERED INTRAVENOUSLY ANAESTHESIA AND INTENSIVE CARE Rubin, J., BROCKUTNE, J. G., DIMOPOULOS, G. E., Downing, J. W., MOSHAL, M. G. 1982; 10 (2): 130-132

  View details for Web of Science ID A1982NP63000007

  View details for PubMedID 6125107

• GASTRO-CONRAY DOES NOT ALTER RESTING LOWER ESOPHAGEAL SPHINCTER PRESSURE IN NORMAL HUMAN-SUBJECTS SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., DIMOPOULOS, G. E., Downing, J. W., MOSHAL, M. G. 1982; 61 (1): 22-23

  Abstract

  The effect of ingestion of 60 ml sodium iothalamate (Gastro-Conray; Maybaker)--a radiographic contrast medium--on resting lower oesophageal sphincter (LOS) pressure was studied in 10 normal human volunteers. Compared with a barium meal, which does cause a fall in LOS pressure, Gastro-Conray did not affect the sphincter tone. The importance of this is discussed.

  View details for Web of Science ID A1982MW85500013

  View details for PubMedID 7058396

• EFFECT OF METOCLOPRAMIDE GIVEN BEFORE ATROPINE SULFATE ON LOWER ESOPHAGEAL SPHINCTER TONE SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., DIMOPOULOS, G. E., Downing, J. W., MOSHAL, M. G. 1982; 61 (13): 465-467

  Abstract

  The effects on lower oesophageal sphincter (LOS) tone of sequential intravenous injections of metoclopramide 10 mg/atropine 0,6 mg and atropine 0,6 mg/metoclopramide 10 mg, given randomly on separate occasions to 8 healthy volunteers, were studied. The administration of metoclopramide increased mean LOS pressure by 13,6 cm H2O (P less than 0,001). Subsequent injection of atropine failed to lower LOS pressure significantly, LOS pressure being sustained at a mean of 11,2 cm H2O above basal control levels (P less than 0,01). In contrast, injection of atropine at a later date in the same subjects lowered the average LOS pressure by 10,5 cm H2O (P less than 0,001), and subsequent intravenous injections of metoclopramide restored LOS pressure to basal levels. The results of this study suggest that metoclopramide should be given prior to atropine before induction of general anaesthesia to counteract the deleterious effects of atropine on LOS tone, thereby helping to reduce the chances of regurgitation and pulmonary aspiration of acid gastric contents.

  View details for Web of Science ID A1982NH44000010

  View details for PubMedID 7064026

• WY-16225 (DEZOCINE), A NEW SYNTHETIC OPIATE AGONIST-ANTAGONIST AND POTENT ANALGESIC - COMPARISON WITH MORPHINE FOR RELIEF OF PAIN AFTER LOWER ABDOMINAL-SURGERY BRITISH JOURNAL OF ANAESTHESIA Downing, J. W., BROCKUTNE, J. G., Barclay, A., SCHWEGMANN, I. L. 1981; 53 (1): 59-64

  Abstract

  Dezocine (Wy 16225), a new analgesic was compared randomly and double-blind with morphine 10 mg in 160 female patients complaining of moderate (group I) or severe (group II) pain after elective lower abdominal surgery; both drugs were given i.m. In group I, pain relief with dezocine 10 and 15 mg was significantly greater than dezocine 5 mg; dezocine 10 mg appeared equipotent with morphine 10 mg. Similar, but statistically insignificant differences were observed in group II. Patient sedation was minimal and untoward side-effects infrequent with all doses of the trial drugs.

  View details for Web of Science ID A1981KZ49100010

  View details for PubMedID 7006657

• BALANCED TOTAL INTRAVENOUS ANESTHESIA AND INTRAOCULAR-PRESSURE ANAESTHESIA AND INTENSIVE CARE NORBURY, A., ROCKE, A. D., BROCKUTNE, J. G., Mackenzie, R., Welsh, N., Downing, J. W. 1981; 9 (3): 255-259

  Abstract

  Twenty patients, aged 21 to 48 years and rated ASA physical status I, were studied during ophthalmic surgery. Ten subjects (Group I) received thiopentone, halothane and nitrous oxide in oxygen, and ten (Group II) received total intravenous anaesthesia, using flunitrazepam and ketamine. Ventilation was controlled mechanically with the aid of a muscle relaxant. Both anaesthetic techniques caused a significant decrease in intraocular pressure. After an initial decline in systolic arterial pressure and an increase in heart rate, cardiovascular status was well maintained in the two series. Side effects were uncommon with both techniques. Balanced total intravenous anaesthesia with flunitrazepam, ketamine and relaxant appears to offer a safe alternative to conventional inhalation narcosis for intraocular surgery.

  View details for Web of Science ID A1981MD91800008

  View details for PubMedID 7283122

• NITROUS-OXIDE ELIMINATION BY THE NEWBORN ANAESTHESIA MANKOWITZ, E., BROCKUTNE, J. G., Downing, J. W. 1981; 36 (11): 1014-1016

  Abstract

  The elimination of nitrous oxide by ten infants whose mothers had received 50% nitrous oxide in oxygen and enflurane 0.6-1% during general anaesthesia for Caesarean section was studied. The concentration of nitrous oxide detected in end-expired gas ranged from 1 to 4 vol% (mean 1.9 vol%). These levels are too low to produce significant diffusion hypoxia in vigorous neonates. However, a minority of infants may be adversely affected and it is recommended that oxygen-enriched air be administered to infants whose mothers have received nitrous oxide.

  View details for Web of Science ID A1981MR68200003

  View details for PubMedID 7316119

• TOTAL INTRAVENOUS ANESTHESIA FOR MAJOR GYNECOLOGICAL SURGERY ANAESTHESIA AND INTENSIVE CARE Rocke, D. A., Rubin, J., BROCKUTNE, J. G., Downing, J. W. 1981; 9 (2): 119-123

  Abstract

  A technique of total intravenous anaesthesia using etomidate by bolus intravenous (IV) injection for induction and by continuous intravenous infusion for maintenance of anaesthesia, with supplementary intravenous fentanyl analgesia, is described. Muscle relaxation was provided by competitive neuromuscular blockade, allowing controlled ventilation of the lungs with oxygen-enriched air. Arterial blood pressure, heart rate and rhythm remained stable throughout the procedure. Few complications were encountered of which the most significant was a 13% incidence of nausea and/or vomiting. Pain on injection, abnormal muscular movements on induction, and post operative venous sequelae were uncommon. Patients were easily rousable shortly after termination of drug infusion. The technique proved acceptable to the patient, surgeon and experienced anaesthetist and, thereby, would appear to offer a reasonable alternative to the more conventional inhalational anaesthetic technique.

  View details for Web of Science ID A1981LU79500002

  View details for PubMedID 7258608

• FACTORS CONTRIBUTING TO A REDUCTION IN ANESTHETIC MORTALITY SOUTH AFRICAN MEDICAL JOURNAL Holloway, A. M., Downing, J. W., BROCKUTNE, J. G. 1981; 59 (11): 361-361

  View details for Web of Science ID A1981LF92700008

  View details for PubMedID 7466494

• GASTRIC AND LOWER ESOPHAGEAL SPHINCTER (LOS) PRESSURES IN EARLY-PREGNANCY BRITISH JOURNAL OF ANAESTHESIA BROCKUTNE, J. G., DOW, T. G., DIMOPOULOS, G. E., Welman, S., Downing, J. W., MOSHAL, M. G. 1981; 53 (4): 381-384

  Abstract

  Gastric (GP) and lower oesophageal sphincter pressures (LOSP) were measured in non-pregnant female volunteers (group I) and pregnant women with (group III) or without (group II) heartburn. Patients in early pregnancy had greater gastric pressures than group I. Mean barrier pressure (LOSP-GP) was significantly decreased in pregnant patients complaining of heartburn (group III) compared with groups I and II.

  View details for Web of Science ID A1981LL49300009

  View details for PubMedID 7225270

• INHALATION OF GASTRIC CONTENTS BRITISH JOURNAL OF ANAESTHESIA MANKOWITZ, E., Khan, M. F., Downing, J. W., BROCKUTNE, J. G., Holloway, A. M. 1981; 53 (7): 778-779

  View details for Web of Science ID A1981LY35900014

  View details for PubMedID 7248133

• 2 NEW DRUGS IMPROVE ANESTHETIC MANAGEMENT IN OBSTETRICS ANESTHESIOLOGY Downing, J. W., BROCKUTNE, J. G., MANKOWITZ, E. 1981; 55 (3): 334-335

  View details for Web of Science ID A1981ME39300034

  View details for PubMedID 7270964

• JOHANNESBURG A-D CIRCUIT SWITCH BRITISH JOURNAL OF ANAESTHESIA Humphrey, D., Downing, J. W., BROCKUTNE, J. G. 1981; 53 (10): 1106-1106

  View details for Web of Science ID A1981ML17300040

  View details for PubMedID 7295455

• HAIRSHAFT IN THE SUBARACHNOID SPACE FOLLOWING LUMBAR PUNCTURE ANESTHESIA AND ANALGESIA BROCKUTNE, J. G., Kallichurum, S., MANKOWITZ, E., Downing, J. W. 1981; 60 (9): 694-695

  View details for Web of Science ID A1981ME57700018

  View details for PubMedID 7196714

• AN EVALUATION OF THE HELLIGE TRANSOXODE (SERVOMED OXYMONITOR SM 361 SYSTEM) - RESPONSE TO HALOTHANE AND ENFLURANCE IN VITRO ANAESTHESIA AND INTENSIVE CARE Downing, J. W., MANKOWITZ, M., BROCKUTNE, J. G., Holloway, A. M. 1981; 9 (2): 140-143

  Abstract

  The effects of halothane (0.5-2%) and enflurane (1-4%) on two Transoxode transcutaneous oxygen (TcPO2) electrodes (Hellige Servomed Oxymonitor SM.361 system) were serially tested in atmospheres of nitrogen, air and 50% nitrous oxide in oxygen. Both TcPO2 electrodes reduced and "read" halothane but no enflurane. Calibration drift was significantly greater (p less than 0.05) after electrode exposure to halothane; 5.40 s.e.m. 1.37 kPa vs enflurane; -0.60 s.e.m. 0.93 kPa. Halothane has a direct effect in rendering the Transoxode inaccurate, which is probably clinically less important than the indirect cardiovascularly medicated influence of both halothane and enflurane on TcPO2 levels. A reduction in the electrode polarisation voltage is recommended to obviate the direct effect of halothane on Transoxode performance.

  View details for Web of Science ID A1981LU79500006

  View details for PubMedID 7258610

• THE PERFORMANCE OF DISPOSABLE INTRAVENOUS CANNULAS - A STUDY OF AVAILABLE CANNULAS IN SOUTH-AFRICA SOUTH AFRICAN MEDICAL JOURNAL MacGillivray, R. G., BROCKUTNE, J. G., Downing, J. W. 1980; 58 (7): 289-293

  Abstract

  A wide range of disposable intravenous cannulas available in South Africa was assessed in terms of their flow characteristics. A great variation was found in the sizes, even among those supposedly of the same size. The various features of each make of cannula are discussed and their packaging is commented on.

  View details for Web of Science ID A1980KD94800019

  View details for PubMedID 6447367

• A PERFORMANCE EVALUATION OF THE SAMSON PEDIATRIC ANESTHETIC SET SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., Downing, J. W., Holloway, A. M. 1980; 58 (7): 294-296

  Abstract

  The performance of the Samson paediatric set, used in Mapleson F mode, has been evaluated in 10 infants. It is a prepacked, sterile, disposable, light-weight and economical set, and would therefore seem to offer advantages over more conventional infant anaesthetic circuits. The oxygenation of patients was adequate throughout and the removal of carbon dioxide effective. No anaesthetic problems were encountered with this circuit. Postoperative chest infection did not occur in the 10 infants studied.

  View details for Web of Science ID A1980KD94800020

  View details for PubMedID 6773159

• DOMPERIDONE ANTAGONIZES THE RELAXANT EFFECT OF ATROPINE ON THE LOWER ESOPHAGEAL SPHINCTER ANESTHESIA AND ANALGESIA BROCKUTNE, J. G. 1980; 59 (12): 921-924

  Abstract

  A zone of increased intraluminal pressure exists at the gastroesophageal junction in man and is believed to act as a physiologic sphincter. Increasing this lower esophageal sphincter (LES) tone is an accepted and useful method in preventing gastroesophageal reflux. The effects of LES tone were studied in 10 healthy volunteers receiving sequential intravenous injections of atropine, 0.6 mg, or domperidone, 10 mg, followed by domperidone, 10 mg, or atropine, 0.6 mg. The order of drug administration was randomized during the first study. Each volunteer was studied a second time, 1 week later, when the order of drug administration was reversed from the first. Administration of atropine decreased mean LES pressure by 12.6 cm H2O (p < 0.001). Subsequent injection of domperidone restored LES tone to near normal. In contrast, initial injection of domperidone approximately 1 week later in the same subjects, mean LES pressure increased by 18.5 cm H2O (p < 0.001). Intravenous injection of atropine, thereafter, failed to decrease mean LES pressure significantly, LES pressure being sustained at a mean of 14.8 cm H2O above basal control levels (p < 0.005). Results of this study suggest that domperidone given prior to atropine, before induction of general anesthesia, may counteract the potentially deleterious effect of atropine on LES tone, and thereby reduce the chances of regurgitation and pulmonary aspiration of acid gastric contents.

  View details for Web of Science ID A1980KW77500005

  View details for PubMedID 7192511

• ASPECTS OF INTRAUTERINE FETAL RESUSCITATION SOUTH AFRICAN MEDICAL JOURNAL Downing, J. W., BROCKUTNE, J. G., MANKOWITZ, M. 1980; 58 (9): 373-375

  Abstract

  An analogy may be drawn between the lungs and placenta regarding distribution and matching of their exchanging flows. Furthermore, prostaglandins probably play a role in restoring the normal pulmonary ventilation-to-perfusion ratio (V/Q) and the uterine (maternal)-to-umbilical (fetal) placental perfusion ratio (Q-q). Availability of oxygen to the fetal brain is probably independent of PaO2, provided cerebral tissue PO2 is above a certain critical level. Oxygen content rather than PO2 of the blood perfusing the fetal brain is the prime factor in maintaining adequate cerebral oxygenation. With the above physiological consideration in mind, the concept of intra-uterine fetal resuscitation is presented. The hypothesis that low concentrations of aneasthetic vapours and 60% oxygen inhaled by the mother in the presence of fetal distress improve placental blood flow matching, and hence fetal cerebral oxygenation, is discussed.

  View details for Web of Science ID A1980KF42400016

  View details for PubMedID 7404259

• BASIC PHARMACOKINETICS SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., KINGSTON, H. G. 1980; 58 (9): 361-365

  Abstract

  This review attempts to deal with the basic principles required to interpret the ever-increasing clinically relevant pharmacokinetic studies. Factors governing drug absorption, distribution and elimination are discussed, as are the terms pharmacodynamics, exponentials, half-life and clearance.

  View details for Web of Science ID A1980KF42400013

  View details for PubMedID 7404256

• FLUNITRAZEPAM FOR THE INTRAVENOUS INDUCTION OF ANESTHESIA IN CHILDREN SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., NORBURY, A. G., Holloway, A. M., Downing, J. W. 1980; 57 (24): 986-987

  Abstract

  Flunitrazepam (Rohypnol) was compared with thiopentone as an anaesthetic induction agent in children between 4 and 12 years of age who underwent elective minor surgical procedures. Successful induction of anaesthesia was achieved in both groups of patients. With flunitrazepam the induction time was longer but not statistically different from that with thiopentone. The incidence of apnoea was higher with thiopentone, but not significantly so. It is concluded that flunitrazepam could prove a reasonable alternative to thiopentone as an intravenous induction agent in children who have to undergo elective minor operations.

  View details for Web of Science ID A1980JV73700012

  View details for PubMedID 6105715

• EFFECT OF DOMPERIDONE ON LOWER ESOPHAGEAL SPHINCTER TONE IN LATE PREGNANCY ANESTHESIOLOGY BROCKUTNE, J. G., Downing, J. W., DIMOPOULOS, G. E., Rubin, J., MOSHAL, M. G. 1980; 52 (4): 321-323

  Abstract

  Increasing the resting lower esophageal sphincter (LES) tone is a useful method of preventing gastroesophageal reflux. The effects of a new antiemetic, domperidone, on LES were studied in 28 subjects. Group I included eight normal nonpregnant control subjects. The remaining 20 pregnant women were divided into two groups, Group II and III--ten parturients without and ten with symptoms of heartburn. Domperidone increased LES pressure by 19, 11 and 10 cm H2O in Groups I, II and III, respectively (P less than 0.05). Domperidone may be a valuable premedicant in some patients to decrease the chance of gastro-esophageal reflux.

  View details for Web of Science ID A1980JM01700007

  View details for PubMedID 7362052

• BIOASSAY OF A WATER-SOLUBLE BENZODIAZEPINE AGAINST SODIUM THIOPENTAL ANESTHESIOLOGY SARNQUIST, F. H., Mathers, W. D., BROCKUTNE, J., Carr, B., CANUP, C., Brown, C. R. 1980; 52 (2): 149-153

  Abstract

  The authors performed a bioassay of midazolam maleate, an investigational, water-soluble benzodiazepine; to determine the duration of sleep after a single intravenous dose. Sodium thiopental was the standard against which the midazolam maleate was assayed. Prior to operation 60 surgical patients were randomly given one of five doses of drugs, either thiopental, 180 or 270 mg, or midazolam maleate, 6.6, 10, or 15 mg. The designated drug was infused intravenously over 20 sec in a double-blind fashion. Sleep was defined as commencing when the patients stopped counting, and ending when they could respond appropriately to verbal commands. Midazolam maleate, 10 mg (9--12 mg represents 95 per cent confidence limits), was found to be equivalent to thiopental, 200 mg, in the duration of sleep induced. Apnea following the infusion was less frequent and of shorter duration after midazolam maleate than after thiopental. It is concluded that midazolam maleate is a satisfactory agent for the induction of anesthesia, and that it is about 20 times as potent as thiopental.

  View details for Web of Science ID A1980JE20300008

  View details for PubMedID 7352669

• POTENTIALLY DANGEROUS FLOW CHARACTERISTICS OF INFANT BOTTLE TEATS SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., Moosa, A. 1980; 58 (18): 708-708

  View details for Web of Science ID A1980KP31900003

  View details for PubMedID 7423310

• DRUGS AND THE FETOMATERNAL UNIT SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., Downing, J. W., MANKOWITZ, E. 1980; 58 (9): 366-369

  Abstract

  Drugs are given to pregnant women for various reasons. The maternal pharmacokinetics, and the short-term and long-term effects that these drugs may have on the newborn infant, are largely unknown. This article presents the current, available knowledge and the factors controlling drug transfer from mother to child.

  View details for Web of Science ID A1980KF42400014

  View details for PubMedID 7404257

• The effects of ergometrine on the lower oesophageal sphincter tone at caesarean section. British journal of obstetrics and gynaecology DIMOPOULOS, G. E., Brock-Utne, J. G., Downing, J. W., Edwards, H., MOSHAL, M. G. 1979; 86 (10): 777-781

  Abstract

  The effect of intravenous ergometrine 0.5 mg during general anaesthesia for Caesarean section on lower oesophageal sphincter (LOS) function was investigated in eight patients. Ergometrine increased the LOS pressure markedly (p less than 0.005).

  View details for PubMedID 508659

• DOES SELF-TAMING WITH SUCCINYLCHOLINE PREVENT POST-OPERATIVE MYALGIA ANESTHESIOLOGY Brodsky, J. B., BROCKUTNE, J. G. 1979; 50 (3): 265-267

  View details for Web of Science ID A1979GP62000027

  View details for PubMedID 434522

• PANCURONIUM PRETREATMENT AND POST-SUCCINYLCHOLINE MYALGIAS ANESTHESIOLOGY Brodsky, J. B., BROCKUTNE, J. G., SAMUELS, S. I. 1979; 51 (3): 259-261

  View details for Web of Science ID A1979HL46100017

  View details for PubMedID 475029

• OBSTETRIC ANESTHESIA SOUTH AFRICAN MEDICAL JOURNAL BULEY, R. J., BROCKUTNE, J. G., Kambaran, S. R., Downing, J. W. 1979; 55 (26): 1054-1054

  View details for Web of Science ID A1979HA43000003

  View details for PubMedID 472957

• ETOMIDATE FOR INDUCTION OF ANESTHESIA AT CESAREAN-SECTION - COMPARISON WITH THIOPENTONE BRITISH JOURNAL OF ANAESTHESIA Downing, J. W., BULEY, R. J., BROCKUTNE, J. G., HOULTON, P. C. 1979; 51 (2): 135-140

  Abstract

  Thirty mothers undergoing elective Caesarean section received thiopentone 3.5 mg kg-1 and 30 received etomidate 0.3 mg kg-1 for induction of anaesthesia. Subsequent management of anaesthesia was identical in both groups. Maternal to fetal base excess differences and the degree of biochemical correlation between mother and infant were more favourable following etomidate than following thiopentone. The clinical status of the newborn was considered superior with etomidate.

  View details for Web of Science ID A1979GJ93800010

  View details for PubMedID 426990

• HYPOTHESIS - VOLATILE ANESTHETIC AGENTS ENHANCE TRANSPLACENTAL EXCHANGE BETWEEN MOTHER AND FETUS - PRELIMINARY-STUDY OF FETAL SCALP BLOOD-GAS CHANGES ASSOCIATED WITH ENFLURANE ANESTHESIA SOUTH AFRICAN MEDICAL JOURNAL Downing, J. W., FAIRBROTHER, P. E., BULEY, R. J., BROCKUTNE, J. G., Kambaran, S. R., Macpherson, T. A. 1979; 55 (1): 17-20

  Abstract

  A hypothesis that volatile anaesthetic agents, represented by enflurane, facilitate transplacental exchange was tested by simultaneous blood sampling of both mother and fetus. A trend towards improved fetal scalp blood gas status and maternal-to-fetal acid-base matching was observed with enflurane. Our results encourage further research into the feasibility of intra-uterine fetal resuscitation by anaesthetically induced promotion of intervillous perfusion.

  View details for Web of Science ID A1979GD24500012

  View details for PubMedID 34236

• POSSIBLE ROLE OF PROLACTIN IN PREVENTING HEARTBURN DURING PREGNANCY SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., DIMOPOULOS, G. E., Welman, S., DOW, T. G., Robertson, E. J., MOSHAL, M. G. 1979; 55 (4): 127-128

  Abstract

  Although heartburn, thought to indicate reflux of gastric contents into the oesophagus, occurs frequently in pregnant women during the last trimester, its aetiology is not clear. Prolactin blood concentrations rise progressively during pregnancy and heartburn is known to disappear spontaneously during the last weeks of pregnancy. In view of this and other factors, motility studies and estimation of serum prolactin levels were carried out on 20 pregnant Black women. Results show that patients with prolactin levels over 3,000 microunits/ml had significantly higher mean barrier presures (sphincter pressure-gastric pressure) than the patients with hormone levels of less than 3,000 microunits/ml (P less than 0,02). No direct correlation could, however, be demonstrated between barrier pressures and prolactin levels (r = 0,3494). It is concluded that further studies would seem to be indicated on an animal model to establish the importance of prolactin in the regulation of the lower oesophageal sphincter tone.

  View details for Web of Science ID A1979GF89300015

  View details for PubMedID 424949

• OBSTETRIC ANESTHESIA SOUTH AFRICAN MEDICAL JOURNAL BULEY, R. J., BROCKUTNE, J. G., Downing, J. W. 1979; 55 (27): 1103-1103

  View details for Web of Science ID A1979HB12600006

  View details for PubMedID 483090

• ACUTE CONFUSIONAL STATES AND DEPRESSION TREATED WITH MAPROTILINE MESYLATE - REPORT OF 4 PATIENTS SUCCESSFULLY TREATED IN AN INTENSIVE-CARE UNIT SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., GOODWIN, N. M., Hicks, J. C. 1979; 55 (16): 641-642

  Abstract

  Four patients admitted to hospital with multiple injuries developed psychiatric symptoms after an initially favourable response to intensive therapy. Alterations in the level of consciousness and behavioural pattern were observed, associated with the presence of acute depression, possibly endogenous in origin. Within 24--48 hours of intravenous administration of maprotiline mesylate (Ludiomil, Ciba), a tetracyclic antidepressant drug, considerable improvement was noted in all 4 patients, with regard to both the depressive state and the clouding of consciousness. The importance of recognizing psychiatric disorders in severely ill patients in an intensive therapy environment is stressed.

  View details for Web of Science ID A1979GR80900018

  View details for PubMedID 462281

• REVERSAL OF NEUROMUSCULAR BLOCKADE BY GLYCOPYRROLATE AND NEOSTIGMINE - STUDY OF THE EFFECTS ON LOWER ESOPHAGEAL SPHINCTER TONE ANAESTHESIA BROCKUTNE, J. G. 1979; 34 (7): 620-623

  Abstract

  The effect of intravenous glycopyrrolate and neostigmine, a drug combination routinely given to antagonize non-depolarising neuromuscular blockade, on lower oesophageal sphincter tone was studied in twenty patients undergoing Caesarean section. Glycopyrrolate 0.6 mg and neostigmine 2.5 mg i.v. increased LOS pressure insignificantly by a mean of 0.2 kPa (P less than 0.1). In contrast, glycopyrrolate 0.6 mg and neostigmine 5 mg increased LOS pressure by a mean of 1.2 kPa (P less than 0.001). The latter dosage of this drug combination thus appears preferable in patients presenting for emergency surgery, if the integrity of the lower oesophageal sphincter is to be maintained during extubation and recovery from general anaesthesia.

  View details for Web of Science ID A1979HL24100007

  View details for PubMedID 517713

• LOWER ESOPHAGEAL SPHINCTER AND REGURGITATION BRITISH JOURNAL OF ANAESTHESIA BROCKUTNE, J. G., Downing, J. W. 1979; 51 (4): 385-386

  View details for Web of Science ID A1979GS13800021

  View details for PubMedID 465265

• LUMBAR EPIDURAL-ANESTHESIA SOUTH AFRICAN MEDICAL JOURNAL Downing, J. W., HOULTON, P. C., BROCKUTNE, J. G., MANKOWITZ, E. 1979; 56 (21): 844-847

  Abstract

  An outline of the anatomy, physiology, indications, contraindications, complications and technique of lumbar epidural anaesthesia is presented.

  View details for Web of Science ID A1979HU83400017

  View details for PubMedID 505233

• METOCLOPRAMIDE AND THE GASTROESOPHAGEAL SPHINCTER ANAESTHESIA BROCKUTNE, J. G. 1979; 34 (1): 81-82

  View details for Web of Science ID A1979GF75900029

  View details for PubMedID 426254

• Preventing fat embolism. British medical journal Brock-Utne, J. 1978; 2 (6129): 54-55

  View details for PubMedID 678811

  View details for PubMedCentralID PMC1605699

• ACTION OF COMMONLY USED ANTI-EMETICS ON LOWER ESOPHAGEAL SPHINCTER BRITISH JOURNAL OF ANAESTHESIA BROCKUTNE, J. G., Rubin, J., Welman, S., DIMOPOULOS, G. E., MOSHAL, M. G., Downing, J. W. 1978; 50 (3): 295-298

  Abstract

  The effects of five antiemetic drugs on the lower oesophageal sphincter (LOS) were studied in five groups, each comprising eight healthy volunteers. Cyclizine, prochlorperazine and metoclopramide have a desirable functional effect on LOS, while promethazine and droperidol were associated with evidence of increased gastro-oesophageal reflux.

  View details for Web of Science ID A1978ER57100016

  View details for PubMedID 638001

• FREE FATTY-ACID AND ARTERIAL OXYGEN CHANGES FOLLOWING MAJOR INJURY - CORRELATION BETWEEN HYPOXEMIA AND INCREASED FREE FATTY-ACID LEVELS JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE Nixon, J. R., BROCKUTNE, J. G. 1978; 18 (1): 23-26

  Abstract

  In a study of uncomplicated patients following major long-bone fracture, plasma free fatty acid levels were found to be statistically significantly higher in those with multiple injury within 12 hours of injury. Arterial oxygen tension was significantly lower in these patients 12 and 24 hours postinjury. A strong positive correlation was found between high FFA and low arterial oxygen tensions in all cases up to 24 hours after injury. The implications of these findings in relation to fat embolism (or post-traumatic) syndrome are discussed.

  View details for Web of Science ID A1978ER82800003

  View details for PubMedID 621762

• ANESTHESIA FOR CESAREAN-SECTION SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., Downing, J. W. 1978; 54 (27): 1120-1120

  View details for Web of Science ID A1978GB97000011

  View details for PubMedID 746477

• ADVANTAGES OF LEFT OVER RIGHT LATERAL TILT FOR CESAREAN-SECTION SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., BULEY, R. J., Downing, J. W., CUERDEN, C. 1978; 54 (12): 489-492

  Abstract

  The relative merits of right and left lateral tilt were assessed in 75 parturients at elective caesarean section. Significant maternal hypotension (aortocaval occlusion) occurred more frequently with rightward tilt (left hip supported). The clinical and biochemical status of the fetus was generally more favourable with left lateral tilt, as were the maternal-to-fetal blood gas gradients and relationships. The routine use of left lateral tilt is advocated.

  View details for Web of Science ID A1978FP68700022

  View details for PubMedID 734581

• MIXING LOCAL-ANESTHETICS BRITISH JOURNAL OF ANAESTHESIA Brodsky, J. B., BROCKUTNE, J. G. 1978; 50 (12): 1269-1269

  View details for Web of Science ID A1978GD35900024

  View details for PubMedID 34414

• EFFECT OF GLYCOPYRROLATE (ROBINUL) ON LOWER ESOPHAGEAL SPHINCTER CANADIAN ANAESTHETISTS SOCIETY JOURNAL BROCKUTNE, J. G., Rubin, J., Welman, S., DIMOPOULOS, G. E., MOSHAL, M. G., Downing, J. W. 1978; 25 (2): 144-146

  Abstract

  Regurgitation and inhalation of acid gastric content, with resultant chemical pneumonitis, remains a common cause of death during anaesthesia. The effects of intravenous glycopyrrolate 0.3 mg on the lower oesophageal sphincter tone was studied in normal human subjects. Glycopyrrolate decreased lower oesophageal sphincter pressure by 0.88 kPa (p less than 0.005). This finding is of clinical importance in the pre-operative preparation of patients presenting for emergency surgery. A drug which decreases lower oesophageal sphincter tone would presumably increase the hazard of gastro-oesophageal reflux and pulmonary aspiration of acid gastric content.

  View details for Web of Science ID A1978ER48000014

  View details for PubMedID 638828

• CONTRASTING EFFECTS OF ENFLURANE ON TRANSPLACENTAL EXCHANGE AFTER METHOHEXITONE AND KETAMINE INDUCTION OF ANESTHESIA FOR CESAREAN-SECTION ANAESTHESIA AND INTENSIVE CARE Downing, J. W., HOULTON, P. J., BROCKUTNE, J. G., BULEY, R. J. 1978; 6 (3): 239-242

  Abstract

  Supplementation of general anaesthesia with enflurane 0.6% before delivery of the foetus by elective Caesarean section, produced contrasting effects after methohexitone and ketamine administration. Enflurane, an inhalational agent causing vasodilation and uterine relaxation, enhanced maternal to foetal transplacental exchange following methohexitone induction of narcosis. This beneficial effect of the volatile agent was not seen after ketamine, a vasoconstrictor drug which stimulates myometrial contraction.

  View details for Web of Science ID A1978FW59300010

  View details for PubMedID 717772

• EFFECT OF METOCLOPRAMIDE ON LOWER ESOPHAGEAL SPHINCTER IN LATE PREGNANCY ANAESTHESIA AND INTENSIVE CARE BROCKUTNE, J. G., DOW, T. G., Welman, S., DIMOPOULOS, G. E., MOSHAL, M. G. 1978; 6 (1): 26-29

  Abstract

  The effects of intravenous metoclopramide (Maxolon) on the lower oesophageal sphincter (LOS) were studied in three groups of patients, one group being normal control and the other two being pregnant females, one without heartburn and the other with. Metoclopramide increases the LOS pressure 20.5, 15.2 and 10.2 cm H2O respectively (p less than 0.005, p less than 0.005 and p less than 0.05). These findings suggest that for patients undergoing elective or emergency obstetrical anaesthesia, intravenous metoclopramide may help reduce the incidence of regurgitation of gastric contents.

  View details for Web of Science ID A1978EV44700003

  View details for PubMedID 665973

• ANESTHETIC INDUCTION FOR CESAREAN-SECTION WITH ETOMIDATE COMPARED WITH THIOPENTONE SOUTH AFRICAN MEDICAL JOURNAL HOULTON, P. J., Downing, J. W., BULEY, R. J., BROCKUTNE, J. G. 1978; 54 (19): 773-775

  Abstract

  Anaesthesia for caesarean section demands a technique that provides perfect narcosis without neonatal depression. To date, no ideal induction agent has been found for obstetric anaesthesia, although thiopentone is still considered the safest. A new agent, etomidate (0,3 mg/kg) has been studied in a group of parturients who underwent elective caesarean section in the left lateral tilt position. The results obtained are compared with those from a similar series, in which the management was identical, except that anaesthesia was induced with thiopentone 3,5 mg/kg. The infants in the present series were usually extremely lively after delivery, and generally sustained respiration in a shorter time than those after thiopentone. In addition, maternal-to-fetal base excess gradients were narrower with etomidate than with thiopentone. Thus etomidate may offer some advantage over thiopentone for anaesthetic induction at elective caesarean section, and appears worthy of further trial.

  View details for Web of Science ID A1978FV37800008

  View details for PubMedID 741308

• ANESTHESIA FOR CESAREAN-SECTION - UPDATED REVIEW OF ITS SPECIAL PROBLEMS AND THEIR MANAGEMENT SOUTH AFRICAN MEDICAL JOURNAL BULEY, R. J., BROCKUTNE, J. G., Downing, J. W., HOULTON, P. J. 1978; 54 (13): 525-527

  Abstract

  We have attempted to update a previous review of the hazards and problems confronting the mother, fetus and anaesthetist at caesarean section. A recent survey of obstetric anaesthesia within the Republic and South West Africa indicates that a significant proportion of anaesthetic services for midwifery are provided by non-specialist practitioners in hospitals outside major population centres. We believe that both mothers and their infants will gain from the careful perusal by their doctors of this review.

  View details for Web of Science ID A1978FQ17500010

  View details for PubMedID 366779

• SURVEY OF OBSTETRIC ANESTHESIA IN REPUBLIC OF SOUTH-AFRICA AND SOUTH-WEST-AFRICA SOUTH AFRICAN MEDICAL JOURNAL BULEY, R. J., BROCKUTNE, J. G., HOULTON, P. J., Downing, J. W. 1978; 54 (12): 486-489

  Abstract

  In this report we analyse the results of a questionaire sent to 341 hospitals throughout the Republic and South West Africa, asking for details of their caesarean section rate and obstetric anesthetic techniques used. Non-specialist practitioners provided 90% of anaesthetic services in the 131 (38,4%) hospitals from which replies were received. General anaesthesia was used in preference to regional anaesthesia in 90% of these hospitals. Of the institutions surveyed, 24% used neither stomach emptying nor antacid therapy pre-operatively. These and other results pertaining to their choice of anaesthetic agents and techniques are presented and discussed.

  View details for Web of Science ID A1978FP68700021

  View details for PubMedID 734580

• INTRAVENOUS KETAMINE ANESTHESIA FOR MAJOR ABDOMINAL-SURGERY - ASSESSMENT OF A TECHNIQUE AND INFLUENCE OF ATARACTIC DRUGS ON PSYCHOMIMETIC EFFECTS OF KETAMINE ANAESTHESIA AND INTENSIVE CARE HOULTON, P. J., Downing, J. W., BROCKUTNE, J. G. 1978; 6 (3): 222-225

  Abstract

  Eighty-two patients presenting for major abdominal surgery were divided into five groups, and received intravenous ketamine, muscle relaxation and controlled ventilation with oxygen-enriched air. For maintenance of anaesthesia patients were given a single intravenous dose of either droperidol 5 mg, diazepam 5 mg, promethazine 25 mg, flunitrazepam 0.5 mg or lorazepam 2 mg, followed by incremental doses of ketamine. Flunitrazepam and lorazepam were the adjuvants associated with the lowest incidence of dreaming and emergence phenomena; postanaesthetic sequelae occurred most frequently with both ketamine/diazepam and ketamine/droperidol anaesthesia. However, the differences between the five groups failed to reach statistical significance.

  View details for Web of Science ID A1978FW59300007

  View details for PubMedID 717770

• EFFECT OF ATROPINE ON LOWER ESOPHAGEAL SPHINCTER IN LATE PREGNANCY OBSTETRICS AND GYNECOLOGY DOW, T. G., BROCKUTNE, J. G., Rubin, J., Welman, S., DIMOPOULOS, G. E., MOSHAL, M. G. 1978; 51 (4): 426-430

  Abstract

  Intraluminal gastroesophageal pressure and pH studies have been performed on 8 nonpregnant women, 10 pregnant women with heartburn, and 10 pregnant women without heartburn. Each patient was tested under resting conditions and after intravenous injection of 0.6 mg atropine. In both groups of pregnant patients the intragastric pressure was found to be higher than that of the nonpregnant subjects. The stomach to lower esophageal sphincter pressure (LESP) gradient under resting conditions was least in the pregnant patients with heartburn. After the administration of atropine, a fall in the LESP occurred in all 3 groups of patients which was most profound in the nonpregnant subjects and in the pregnant patients without heartburn. These changes and the pH recordings of the lower esophagus indicate the adverse effect that atropine has on the competency of the LESP both in pregnancy and in the nonpregnant state. Atropine should therefore be used with caution as a premedicant and preferably combined with metoclopramide (Maxolon).

  View details for Web of Science ID A1978EV01200009

  View details for PubMedID 26899

• ANESTHETIC INDUCTION FOR CESAREAN-SECTION WITH THIOPENTONE, METHOHEXITONE AND KETAMINE SOUTH AFRICAN MEDICAL JOURNAL HOULTON, P. C., Downing, J. W., BULEY, R. J., BROCKUTNE, J. G. 1978; 54 (20): 818-820

  Abstract

  Thiopentone (3,5 mg/kg) was compared with methohexitone (1 mg/kg) and 'low-dose' ketamine (1 mg/kg) for induction of obstetric anaesthesia. Anaesthesia was maintained with gas, oxygen, muscle relaxant and 0.6% enflurane. Fetal oxygenation was superior with thiopentone, but blood gas/acid base status was otherwise comparable among the different agents. Methohexitone and low-dose ketamine appear to offer reasonable alternatives to thiopentone for anaesthetic induction at caesarean section.

  View details for Web of Science ID A1978FW25800014

  View details for PubMedID 33455

• LOWER ESOPHAGEAL SPHINCTER TONE DURING REVERSAL OF NEUROMUSCULAR BLOCKADE BY ATROPINE AND NEOSTIGMINE ANESTHESIA AND ANALGESIA BROCKUTNE, J. G., Downing, J. W., Welman, S., DIMOPOULOS, G. E., MOSHAL, M. G. 1978; 57 (2): 171-174

  Abstract

  The effect on lower esophageal sphincter (LES) pressure of IV atropine and neostigmine, a drug combination routinely given to antagonize nondepolarizing neuromusclar blockade at the end of a general anesthetic, was studied in 22 patients undergoing cesarean section. Atropine 1.2 mg and neostigmine 2.5 mg IV decreased LES pressure insignificantly by a mean of 0.7 kPa (p less than 0.1). In contrast, atropine 1.2 mg and neostigmine 5 mg increased LES pressure by a mean of 1.4 kPa (p less than 0.001). The latter dosage of this drug combination, therefore, appears preferable in patients presenting for emergency surgery if the integrity of the lower esophageal sphincter is to be maintained during extubation and recovery from general anesthesia.

  View details for Web of Science ID A1978EU86000004

  View details for PubMedID 565153

• USE OF NEUROLEPT ANALGESIA FOR GASTROINTESTINAL ENDOSCOPY SOUTH AFRICAN MEDICAL JOURNAL Rubin, J., BRYER, J. V., BROCKUTNE, J. G., MOSHAL, M. G. 1977; 52 (21): 835-837

  Abstract

  A prospective double-blind study of the effects of sedation in 142 patients undergoing gastro-intestinal endoscopy was performed. Four regimens were studied (neurolept analgesia with and without topical anaesthesia, and anticholinergic and topical anaesthesia, with and without diazepam). Droperidol and fentanyl without topical anaesthesia yielded the best results as far as tolerance and side-effects were concerned. It is suggested that this form of neurolept analgesia be used for gastro-intestinal endoscopy.

  View details for Web of Science ID A1977EA47600020

  View details for PubMedID 345484

• LARYNGEAL EDEMA ASSOCIATED WITH PRE-ECLAMPTIC TOXEMIA ANAESTHESIA BROCKUTNE, J. G., Downing, J. W., SEEDAT, F. 1977; 32 (6): 556-558

  Abstract

  Pre-eclamptic toxaemia is a common complication of late pregnancy. However, the occurrence of clinically unsuspected laryngeal oedema has not, to the authors' knowledge, been described previously. Experience of such a case leads them to recommend that a selection of tracheal tubes ranging from 8 to 4-5 mm, be available when anaesthesia is undertaken in patients who have oedema associated with pre-eclamptic toxaemia.

  View details for Web of Science ID A1977DL45100007

  View details for PubMedID 879467

• FASTING VOLUME AND ACIDITY OF STOMACH CONTENTS ASSOCIATED WITH GASTROINTESTINAL SYMPTOMS ANAESTHESIA BROCKUTNE, J. G., MOSHAL, M. G., Downing, J. W., SPITAELS, J. M., STIEBEL, R. 1977; 32 (8): 749-752

  Abstract

  Acid aspiration in an important cause of anaesthetic mortality. 430 patients referred for gastric analysis were reviewed. According to observations made at endoscopy, patients were divided into 4 groups--no abnormality, oesophagitis/gastritis, gastric ulcers and duodenal ulcers. The volume of gastric juice varied from 0 to 400 ml, and the pH from 0-8 to 8. The percentage of patients with overnight fasting gastric volume over 25 ml and a pH of less than 2-5 was disturbingly high in all groups: controls 38-5%, oesophagitis/gastritis 51-2%, gastric ulcers 40-0%, duodenal ulcers 73-3%. This last figure is significantly greater than the group with no detectable abnormality. These results indicated that the stomach of a fasting patient often contains sufficient volume of acid gastric juice to place the subject at risk from acid aspiration during anaesthesia. Antacid therapy in all these patients seems imperative and consideration should also be given to preoperative gastric aspiration before induction of general anaesthesia.

  View details for Web of Science ID A1977DU93000002

  View details for PubMedID 920916

• LARYNGEAL INCOMPETENCE DURING EXPERIMENTAL RELATIVE ANALGESIA USING 50-PERCENT NITROUS-OXIDE IN OXYGEN - PRELIMINARY-REPORT BRITISH JOURNAL OF ANAESTHESIA Rubin, J., BROCKUTNE, J. G., Greenberg, M., Bortz, J., Downing, J. W. 1977; 49 (10): 1005-1008

  Abstract

  Ten healthy adult volunteers inhaled 50% nitrous oxide in oxygen while dental treatment was simulated for a period of 30 min. During this time 15 ml of radio-opaque dye was placed at the back of the tongue. A similar control study was performed 1 week later, the subjects inhaling pure oxygen without nitrous oxide. X-ray examination revealed that two of the 10 volunteers had aspirated dye while breathing nitrous oxide and oxygen, but no aspiration was apparent in the control study.

  View details for Web of Science ID A1977DX88100008

  View details for PubMedID 921863

• BRONCHODILATORS AND PHYSIOTHERAPY DURING LONG-TERM MECHANICAL VENTILATION OF LUNGS ANAESTHESIA AND INTENSIVE CARE WINNING, T. J., BROCKUTNE, J. G., GOODWIN, N. M. 1977; 5 (1): 48-50

  Abstract

  The effects of physiotherapy and hexaprenaline sulphate administration were studied on 10 patients requiring mechanical ventilation. No significant changes in arterial oxygen tensions were noted, but alveolar pressure fell significantly after treatment, indicating improvement in pulmonary compliance.

  View details for Web of Science ID A1977CY44800007

  View details for PubMedID 402865

• CLOSED-CIRCUIT (REBREATHING) ENFLURANE ANESTHESIA SOUTH AFRICAN MEDICAL JOURNAL Downing, J. W., BROCKUTNE, J. G. 1977; 52 (13): 514-517

  Abstract

  The economics and advantages of non-rebreathing (semiclosed) versus rebreathing ('closed') circuit enflurane anaesthesia in spontaneously breathing patients, anaesthetized for ophthalmic procedures usually lasting less than 1 hour, were investigated. An average of 42, 5 ml liquid enflurane was used per hour of anaesthesia with the non-rebreathing apparatus, a figure close to the calcuated approximate enflurane usage for the first hour of anaesthesia (42,0 ml). Approximately half this volume was required for anaesthesia via the vaporizer out of circle (VOC) rebreathing system (19,0 ml/h; P less than 0,001). A further significant decrease resulted with the use of the vaporizer in circle (VIC) system (13,5 ml/h; P less than 0.001), but the surgical conditions provided by the latter were less satisfactory. Actual enflurane utilization with both VOC and VIC was greater than that expected for the first hour of anaesthesia (calculated approximate usage 15,0 and 11,0 ml/h respectively). Enflurane anaesthesia with the vaporizer out of circle is recommended for routine surgical procedures.

  View details for Web of Science ID A1977DU56500012

  View details for PubMedID 918793

• EFFECT OF HYOSCINE AND ATROPINE ON LOWER ESOPHAGEAL SPHINCTER ANAESTHESIA AND INTENSIVE CARE BROCKUTNE, J. G., Rubin, J., MCARAVEY, R., DOW, T. G., Welman, S., DIMOPOULOS, G. E., MOSHAL, M. G. 1977; 5 (3): 223-225

  Abstract

  The effects of intravenous hyoscine 0-4 mg and atropine 0-6 mg on lower oesophageal sphincter tone were studied in normal human subjects. Hyoscine and atropine both decreased the lower oesophageal sphincter (L.O.S) pressure by approximately 11 cm H2O (p less than 0-01). There was also an increased incidence of reflux as seen by an indwelling pH electrode in the lower oesophagus. These findings are relevant to the preoperative preparation of patients presenting for emergency obstetrical anaesthesia; since gastro-oesophagus reflux and pulmonary aspiration of acid gastric content continues to be a significant cause of morbidity and mortality.

  View details for Web of Science ID A1977DY69900007

  View details for PubMedID 19986

• EFFECT OF CYCLIZINE HYDROCHLORIDE ON LOWER ESOPHAGEAL SPHINCTER PRESSURE IN MAN SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., Downing, J. W., DIMOPOULOS, G. E., MOSHAL, M. G. 1977; 51 (26): 977-978

  Abstract

  Gastro-oesophageal reflux and pulmonary aspiration of acid gastric content remain significant causes of morbidity and mortality. A drug which increases lower oesophageal sphincter (LOS) tone would reduce this hazard. The effect of LOS function of intravenous cyclizine (25 mg), in half the recommended adult dose, was investigated in 8 volunteers. Cyclizine increased the LOS pressure by an average of 14,4 cm H2O (P less than 0,005). Cyclizine, like metoclopramide, has a desirable functional effect on the LOS. Both drugs are, in addition, potent anti-emetics. On the grounds of these pharmacological properties they are recommended in the preparation of patients for emergency surgery.

  View details for Web of Science ID A1977DK95600019

  View details for PubMedID 18802

• NAUSEA AND VOMITING AFTER ANESTHESIA AND MINOR SURGERY ANESTHESIA AND ANALGESIA WINNING, T. J., BROCKUTNE, J. G., Downing, J. W. 1977; 56 (5): 674-677

  Abstract

  The antiemetic effects of droperidol, diphenidol, and placebo were compared in 210 patients subjected to minor gynecologic or urologic procedures. Atropine (0.6 mg), meperidine (1 mg/kg) body mass, and either droperidol (5 mg), diphenidol (40 mg), or 2 ml of 0.9% saline were administered IM, 1 hour before general anesthesia. Trial drugs were presented in coded ampules so that the study was conducted double-blind. Droperidol appeared superior to both diphenidol (p less than 0.01) and placebo (p less than 0.001) in the prevention of vomiting, and reduced the incidence of nausea when compared to saline (p less than 0.05). Forty-four patients experienced side effects, which occurred with similar frequency in the 3 groups studied.

  View details for Web of Science ID A1977DX22300014

  View details for PubMedID 562092

• GASTRIC VOLUME AND ACIDITY AT CESAREAN-SECTION SOUTH AFRICAN MEDICAL JOURNAL BROCKUTNE, J. G., Barclay, A. J., HOULTON, P. J. 1977; 52 (5): 182-183

  Abstract

  The pulmonary acid aspiration (Mendelson's) syndrome may present after regurgitation and inhalation of acid gastric content during obstetric anesthesia. The stomach contents of 70 mothers were aspirated at caesarean section after pre-operative gastric 'emptying' and alkaline ingestion. The acidity of the gastric aspirate was analysed and volumes were measured. The patients were divided into 5 groups according to the time when gastric aspiration was carried out. A 'safe' gastric pH (pH greater than 3.5) was found in all patients up to 2 hours after antacid ingestion (groups 1-3). However, 2 1/2 hours after antacid ingestion (group 4y, 50% of patients had gastric volumes in excess of 25 ml and a pH of less than 3.5. We therefore recommend that, if general anaesthesia is to be induced or is in progress 2 hours after antacid therapy, the alkaline regimen should be resumed after repeated gastric aspiration.

  View details for Web of Science ID A1977DP05400014

  View details for PubMedID 19850

• RIGHT VERSUS LEFT LATERAL TILT FOR CESAREAN-SECTION BRITISH JOURNAL OF ANAESTHESIA BULEY, R. J., Downing, J. W., BROCKUTNE, J. G., CUERDEN, C. 1977; 49 (10): 1009-1015

  Abstract

  In 60 mothers with normal placental function, the relative merits of right and left lateral tilt during Caesarean section were assessed. Maternal-foetal biochemical values and relationships were generally more satisfactory with the left lateral position. The incidence of hypotension (revealed aorto-caval occlusion) before and after induction of anaesthesia, was significantly greater (P less than 0.001) with the "right side down" posture.

  View details for Web of Science ID A1977DX88100009

  View details for PubMedID 921864

• ADMINISTRATION OF METOCLOPRAMIDE WITH ATROPINE - DRUG INTERACTION EFFECT ON GASTROESOPHAGEAL SPHINCTER IN MAN ANAESTHESIA BROCKUTNE, J. G., Rubin, J., Downing, J. W., DIMOPOULOS, G. E., MOSHAL, M. G., NAICKER, M. 1976; 31 (9): 1186-1190

  Abstract

  The effects of intravenous atropine 0-6 mg alone, metoclopramide (Maxolon) 10mg alone and atropine 0-6 mg and metoclopramide 10 mg in combination, on the lower oesophageal sphincter (LOS) were studied in three groups of normal human volunteers. Atropine decreased the LOS pressure by an average of 8 cm H2O (P less than 0-001), whereas metoclopramide increased the LOS pressure by a mean of 29 cmH2O compared to basal values (P less than 0-001). In contrast, no change in sphincter tone was noted following injection of atropine-metaclopramide mixture. These findings are relevant to the pre-operative preparation of patients presenting for emergency anaesthesia, since gasgro-oesophageal reflux and pulmonary aspiration of acid gastric content continues to be a significant cause of morbidity and mortality.

  View details for Web of Science ID A1976CK62200003

  View details for PubMedID 1015602

• PSYCHIATRIC PROBLEMS IN INTENSIVE-CARE - 5 PATIENTS WITH ACUTE CONFUSIONAL STATES AND DEPRESSION ANAESTHESIA BROCKUTNE, J. G., CHEETHAM, R. W., GOODWIN, N. M. 1976; 31 (3): 380-384

  Abstract

  Five case histories are presented of patients with multiple trauma or severe infection, who developed psychiatric symptoms after an initially favourable response to intensive therapy. Alterations in the level of consciousness and behavioural pattern were observed, associated with the presence of acute depression, possibly primarily endogenous in origin. Following intravenous Clomipramine administration, considerable improvement was noted in all five patients, regarding both the depressive state and the clouding of consciousness. The importance of recognising psychiatric disorder in severly ill patients in an intensive therapy environment is stressed.

  View details for Web of Science ID A1976BM21500002

  View details for PubMedID 776026

• LARYNGEAL INCOMPETENCE DURING NEUROLEPTANALGESIA IN COMBINATION WITH DIAZEPAM BRITISH JOURNAL OF ANAESTHESIA BROCKUTNE, J. G., WINNING, T. J., Rubin, J., KINGSTON, H. G. 1976; 48 (7): 699-701

  Abstract

  In eight patients, following carotid angiography under neuroleptanalgesia, a radiopaque dye was instilled into the pharynx. The chest was x-rayed 15 min later. All eight patients were observed to have aspirated the dye. The technique of neuroleptanalgesia described should not be used without safeguarding the airway in patients liable to regurgitate and inhale gastric contents.

  View details for Web of Science ID A1976BX70400014

  View details for PubMedID 1016647

• Chest physiotherapy during mechanical ventilation. Anaesthesia and intensive care Brock-Utne, J. G., WINNING, T. J., Botha, E., GOODWIN, N. M. 1975; 3 (3): 234-236

  Abstract

  The effects of three different physiotherapy techniques on arterial oxygen tensions and A-aO2 gradients were evaluated in 17 patients subjected to mechanical ventilation. No significant changes were detected and the clinical significance of these findings, which contrast with those of other investigators, is discussed.

  View details for PubMedID 1101730

• A simple clinical method of quantitating the effects of chest physiotherapy in mechanically ventilated patients. Anaesthesia and intensive care WINNING, T. J., Brock-Utne, J. G., GOODWIN, N. M. 1975; 3 (3): 237-238

  Abstract

  A simple clinical method, allowing quantitive assessment of the effects of chest physiotherapy on patients subjected to I.P.P.V., is presented. The method involves measuring of the "alveolar" pressure using the end-expiratory retard mechanism available on the Bennet MA 1 (volume cycled) ventilator. Using this simple technique three different methods of physiotherapy were shown to significantly lower alveolar pressure, indicating an increase in pulmonary compliance. The inhalation of acetyl cysteine however, appeared to render treatment less effective in this regard.

  View details for PubMedID 1101731

• Benzoctamine. A preliminary report on a new sedative drug. Anaesthesia GOODWIN, N. M., Brock-Utne, J. G., Downing, J. W., Coleman, A. J. 1974; 29 (6): 715-720

  View details for PubMedID 4479725

• [Problems concerning the pregnant woman with latent schizophrenia]. Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række Brock-Utne, J. G. 1974; 94 (25): 1535-?

  View details for PubMedID 4418177

• [Medical problems in students before examination]. Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række Brock-Utne, J. G. 1972; 12 (13): 937-938

  View details for PubMedID 5030134

• Diagnostic abdominal paracentesis. British medical journal GJESSING, J., Oskarsson, B. M., Tomlin, P. J., Brock-Utne, J. 1972; 1 (5800): 617-619

  Abstract

  Diagnostic abdominal paracentesis was performed in 43 patients in whom the diagnosis was uncertain. It was found to be particularly useful in abdominal pain resulting from trauma. In 12 patients the findings led to their being spared a laparotomy while in several other patients they led to very early diagnosis of the lesion responsible enabling early surgical treatment to be undertaken. A false-negative result was obtained in only one patient. It is concluded that diagnostic abdominal paracentesis is an extremely reliable diagnostic aid and can lead to improved surgical care of the patient with atypical acute abdominal pain.

  View details for PubMedID 5013838

• GLAUCOMA AND SYSTEMIC LUPUS ERYTHEMATOSUS BRITISH MEDICAL JOURNAL BROCKUTN, J. G., Good, C. J. 1971; 4 (5789): 747-?

  View details for Web of Science ID A1971L133300030

  View details for PubMedID 5129626