In a non-blinded observational study, we have tested the null hypothesis that there is no differe... more In a non-blinded observational study, we have tested the null hypothesis that there is no difference in local anaesthetic requirements for subarachnoid anaesthesia between women presenting for Caesarean section at term or preterm (38-42 and 28-35 weeks' gestation, respectively). Using a combined spinal-extradural technique, 2.25 ml of 0.5% hyperbaric bupivacaine was given, in the sitting position, to 50 women presenting for Caesarean section. In 21 of 25 preterm women, adequate sensory block for surgery did not develop (P:0.001) and they required supplementary extradural local anaesthetic (median 8 ml of 2% lignocaine with 1:200 000 adrenaline (interquartile range 4-12 ml)); preterm women not requiring extradural supplementation were at the upper end of the gestational range. There was a strong linear correlation between increasing gestation and block height in the preterm group (Spearman rank correlation coefficient:0.74; 95% confidence intervals 0.49, 0.88). All women in the term group developed adequate anaesthesia with the subarachnoid dose alone. Onset of anaesthesia was slower in the preterm group (median 15 vs 5 min) with a lower incidence of hypotension (P:0.0005).
Currently, there is no cure for Alzheimer's. But drug and non-drug treatments may help with both ... more Currently, there is no cure for Alzheimer's. But drug and non-drug treatments may help with both cognitive and behavioral symptoms. Researchers are looking for new treatments to alter the course of the disease and improve the quality of life for people with dementia. Intralipid treatment is first suggested here for the treatment of Alzheimer disease. It should be given intravenously on a monthly basis according to each patient's response. Clinical studies should be done in order to evaluate this new treatment modality.
The number of all medical publications in 1990 from online database EMBASE was related to physici... more The number of all medical publications in 1990 from online database EMBASE was related to physician population in 20 countries. United Kingdom ranked first, with Israel in second place.1 It was interesting to compare the country of the first author under the title of "Pediatrics" to the physician population of that country. For that the Excerpta Medica Abstract Journals on Silver-Platter CD-ROM of 1990 was searched. Excerpta Medica Abstract Journals encompasses 45 abstract journals published every year, covering a wide range of medical and biomedical subjects.
Open-chest cardiopulmonary resuscitation (CPR) is physiologically superior to all external CPR me... more Open-chest cardiopulmonary resuscitation (CPR) is physiologically superior to all external CPR methods studied thus far (P. Safer, Ann. Emerg. Med., 13 (19841856) [l]. Open-chest CPR should again be taught to physicians, and used more often after prolonged cardiac arrest. An extensive review on open cardiac massage is presented herein.
Awareness during anesthesia is as old as anesthesia itself. Using muscle relaxing drugs, operatio... more Awareness during anesthesia is as old as anesthesia itself. Using muscle relaxing drugs, operations can be done on a relaxed but fully aware patient. The problem of intra-anesthetic awareness still exists despite the advances in anesthetic drugs and monitoring. This article reviews the subject from some aspects including its causes, signs, tests and medico-legal points. Awareness during anesthesia can be looked at as 'the invisible scars of surgery.'
Bronchospasm is a well-recognized complication of general anesthesia. There is therefore a prefer... more Bronchospasm is a well-recognized complication of general anesthesia. There is therefore a preference for regional anesthesia in those surgical patients suffering from asthma. Regional anesthesia avoids the administration of general anesthetics and intubation of the trachea which may initiate acute bronchospasm (1). The literature describes only a few rare cases of acute bronchospastic attack during epidural or spinal anesthesia (2).We describe herein two cases of acute bronchospasm during epidural anesthesia for lower limb surgery.
The concept of combined spinal-epidural-general anesthesia (CSEGA) was recently described in a ca... more The concept of combined spinal-epidural-general anesthesia (CSEGA) was recently described in a case report [1]. This method might also be useful for upper abdominal operations. It would be beneficial if we could reduce the amount of muscle relaxants necessary for an operation, especially for patients with cirrhosis or renal failure. We designed this study in order to evaluate whether this technique can also be extended for upper abdominal operations without the use of muscle relaxants or intravenous anesthetics, except for the endotracheal intubation. No comparisons were made with other types of anesthesia in terms of the effectiveness of CSEGA. Patients with lower abdominal operations were also included in order to evaluate the possibility of ventilating them throughout the operation with the use of only 0.5% isoflurane, with no muscle relaxants or i.v. anesthesia. Fifteen patients aged 35-73 years (mean 61.4 years), seven males and eight females, were included in the study after an informed consent was obtained (Table 1). One liter of Lactated Ringer's solution was given before starting anesthesia. While the patient was lying on one side an 18G epidural needle (Portex Minipack, Kent, UK) was inserted at the L2-3 interspace. An epidural catheter was introduced through it with its tip directed cephalad, without injecting anything through it. At the L3-4 interspace a spinal needle (22G Quincke for patients aged more than 60 years, and 24G Sprotte for patients less than 60 years) was inserted until CSF was obtained. Three milliliters of 0.5% heavy bupivacaine (Astra, Sweden) was injected through the spinal needle. The patient was then laid on his/her back. Five minutes later, after monitoring the regional anesthetic level, an endotracheal tube was inserted and 0.01mg.kg 1
Birnbach and Danzer [1] have recently published a comment on the production of metallic micropart... more Birnbach and Danzer [1] have recently published a comment on the production of metallic microparticles by the needle-through-needle technique for combined spinal-epidural anesthesia. They quoted an abstract by Holst et al. [2] dated 1994 reporting that "there were no metallic impurities as detected by atomic absorption measurements." However, in another article by Herman et al. [3] entitled "No additional metal particle formation using needle-through-needle combined epidural/spinal technique" there is a photomicrograph (• showing a "notching d e f e c t. . , within the lumen along the tract of the spinal needle at the tip." In the clinical setting, an epidural catheter is pushed through the epidural shaft after the spinal needle is withdrawn, so the "notching defect," which is an accumulation of metallic microparticles detached from its surface, can be pushed forward by the force exerted to insert the catheter into the epidural space. Birnbach and Danzer also questioned our hypothesis that these metallic microparticles can cause aseptic meningitis. However, since 1994 there have been two case reports of aseptic meningitis involving the needlethrough-needle technique [4,5]. Concerning both of these reports, we have commented on the possibility that these metallic microparticles should be considered in the differential diagnosis. Only future case reports will show if we, or Birnbach and Danzer, are correct on that issue. However, since Birnbach and Danzer mentioned the Eldor needle saying that "the information 'found in Dr. Eldor's letter does not prove the superiority of alternative methods of combined spinal-epidural anesthesia (CSE) (such as the Eldor needle) as compared with the needle-through-needle technique," we would like to submit the following figure of the tips of the needle-through-needle (Fig.
Post-spinal headache (PSH) is still a serious complication of accidental dural puncture in obstet... more Post-spinal headache (PSH) is still a serious complication of accidental dural puncture in obstetric pract.ice". A pro phylactic extradural blood patch was suggested", with conflicting results", Recently it was described" that epidural morphine injections relieved PSH. It also relieved PSH 5 days after the dural puncture'', A case is reported of a parturient who developed a PSH and responded to
In a non-blinded observational study, we have tested the null hypothesis that there is no differe... more In a non-blinded observational study, we have tested the null hypothesis that there is no difference in local anaesthetic requirements for subarachnoid anaesthesia between women presenting for Caesarean section at term or preterm (38-42 and 28-35 weeks' gestation, respectively). Using a combined spinal-extradural technique, 2.25 ml of 0.5% hyperbaric bupivacaine was given, in the sitting position, to 50 women presenting for Caesarean section. In 21 of 25 preterm women, adequate sensory block for surgery did not develop (P:0.001) and they required supplementary extradural local anaesthetic (median 8 ml of 2% lignocaine with 1:200 000 adrenaline (interquartile range 4-12 ml)); preterm women not requiring extradural supplementation were at the upper end of the gestational range. There was a strong linear correlation between increasing gestation and block height in the preterm group (Spearman rank correlation coefficient:0.74; 95% confidence intervals 0.49, 0.88). All women in the term group developed adequate anaesthesia with the subarachnoid dose alone. Onset of anaesthesia was slower in the preterm group (median 15 vs 5 min) with a lower incidence of hypotension (P:0.0005).
Currently, there is no cure for Alzheimer's. But drug and non-drug treatments may help with both ... more Currently, there is no cure for Alzheimer's. But drug and non-drug treatments may help with both cognitive and behavioral symptoms. Researchers are looking for new treatments to alter the course of the disease and improve the quality of life for people with dementia. Intralipid treatment is first suggested here for the treatment of Alzheimer disease. It should be given intravenously on a monthly basis according to each patient's response. Clinical studies should be done in order to evaluate this new treatment modality.
The number of all medical publications in 1990 from online database EMBASE was related to physici... more The number of all medical publications in 1990 from online database EMBASE was related to physician population in 20 countries. United Kingdom ranked first, with Israel in second place.1 It was interesting to compare the country of the first author under the title of "Pediatrics" to the physician population of that country. For that the Excerpta Medica Abstract Journals on Silver-Platter CD-ROM of 1990 was searched. Excerpta Medica Abstract Journals encompasses 45 abstract journals published every year, covering a wide range of medical and biomedical subjects.
Open-chest cardiopulmonary resuscitation (CPR) is physiologically superior to all external CPR me... more Open-chest cardiopulmonary resuscitation (CPR) is physiologically superior to all external CPR methods studied thus far (P. Safer, Ann. Emerg. Med., 13 (19841856) [l]. Open-chest CPR should again be taught to physicians, and used more often after prolonged cardiac arrest. An extensive review on open cardiac massage is presented herein.
Awareness during anesthesia is as old as anesthesia itself. Using muscle relaxing drugs, operatio... more Awareness during anesthesia is as old as anesthesia itself. Using muscle relaxing drugs, operations can be done on a relaxed but fully aware patient. The problem of intra-anesthetic awareness still exists despite the advances in anesthetic drugs and monitoring. This article reviews the subject from some aspects including its causes, signs, tests and medico-legal points. Awareness during anesthesia can be looked at as 'the invisible scars of surgery.'
Bronchospasm is a well-recognized complication of general anesthesia. There is therefore a prefer... more Bronchospasm is a well-recognized complication of general anesthesia. There is therefore a preference for regional anesthesia in those surgical patients suffering from asthma. Regional anesthesia avoids the administration of general anesthetics and intubation of the trachea which may initiate acute bronchospasm (1). The literature describes only a few rare cases of acute bronchospastic attack during epidural or spinal anesthesia (2).We describe herein two cases of acute bronchospasm during epidural anesthesia for lower limb surgery.
The concept of combined spinal-epidural-general anesthesia (CSEGA) was recently described in a ca... more The concept of combined spinal-epidural-general anesthesia (CSEGA) was recently described in a case report [1]. This method might also be useful for upper abdominal operations. It would be beneficial if we could reduce the amount of muscle relaxants necessary for an operation, especially for patients with cirrhosis or renal failure. We designed this study in order to evaluate whether this technique can also be extended for upper abdominal operations without the use of muscle relaxants or intravenous anesthetics, except for the endotracheal intubation. No comparisons were made with other types of anesthesia in terms of the effectiveness of CSEGA. Patients with lower abdominal operations were also included in order to evaluate the possibility of ventilating them throughout the operation with the use of only 0.5% isoflurane, with no muscle relaxants or i.v. anesthesia. Fifteen patients aged 35-73 years (mean 61.4 years), seven males and eight females, were included in the study after an informed consent was obtained (Table 1). One liter of Lactated Ringer's solution was given before starting anesthesia. While the patient was lying on one side an 18G epidural needle (Portex Minipack, Kent, UK) was inserted at the L2-3 interspace. An epidural catheter was introduced through it with its tip directed cephalad, without injecting anything through it. At the L3-4 interspace a spinal needle (22G Quincke for patients aged more than 60 years, and 24G Sprotte for patients less than 60 years) was inserted until CSF was obtained. Three milliliters of 0.5% heavy bupivacaine (Astra, Sweden) was injected through the spinal needle. The patient was then laid on his/her back. Five minutes later, after monitoring the regional anesthetic level, an endotracheal tube was inserted and 0.01mg.kg 1
Birnbach and Danzer [1] have recently published a comment on the production of metallic micropart... more Birnbach and Danzer [1] have recently published a comment on the production of metallic microparticles by the needle-through-needle technique for combined spinal-epidural anesthesia. They quoted an abstract by Holst et al. [2] dated 1994 reporting that "there were no metallic impurities as detected by atomic absorption measurements." However, in another article by Herman et al. [3] entitled "No additional metal particle formation using needle-through-needle combined epidural/spinal technique" there is a photomicrograph (• showing a "notching d e f e c t. . , within the lumen along the tract of the spinal needle at the tip." In the clinical setting, an epidural catheter is pushed through the epidural shaft after the spinal needle is withdrawn, so the "notching defect," which is an accumulation of metallic microparticles detached from its surface, can be pushed forward by the force exerted to insert the catheter into the epidural space. Birnbach and Danzer also questioned our hypothesis that these metallic microparticles can cause aseptic meningitis. However, since 1994 there have been two case reports of aseptic meningitis involving the needlethrough-needle technique [4,5]. Concerning both of these reports, we have commented on the possibility that these metallic microparticles should be considered in the differential diagnosis. Only future case reports will show if we, or Birnbach and Danzer, are correct on that issue. However, since Birnbach and Danzer mentioned the Eldor needle saying that "the information 'found in Dr. Eldor's letter does not prove the superiority of alternative methods of combined spinal-epidural anesthesia (CSE) (such as the Eldor needle) as compared with the needle-through-needle technique," we would like to submit the following figure of the tips of the needle-through-needle (Fig.
Post-spinal headache (PSH) is still a serious complication of accidental dural puncture in obstet... more Post-spinal headache (PSH) is still a serious complication of accidental dural puncture in obstetric pract.ice". A pro phylactic extradural blood patch was suggested", with conflicting results", Recently it was described" that epidural morphine injections relieved PSH. It also relieved PSH 5 days after the dural puncture'', A case is reported of a parturient who developed a PSH and responded to
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Papers by Joseph Eldor