Joseph Eldor

Open chest cardiac massage: A review

Open-chest cardiopulmonary resuscitation (CPR) is physiologically superior to all external CPR methods studied thus far (P. Safer, Ann. Emerg. Med., 13 (1984) 856). 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.

Intra-anesthetic awareness

Abstract 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.’

Over-transfusion ascites

A 12-year-old girl was injured in a traffic accident and suffered fractures of all the long bones of both legs. During the operation she received 10 l of lactated Ringers solution, 3 l of 0.9% NaCl, and 2 l of 5% glucose, until blood was available, because of difficulty in its cross-matching. Her hemoglobin dropped to 4.9 g%. After the operation a distension of the abdomen was noted. An abdominal tap confirmed ascites. A simultaneous intravenous pyelogram and retrograde cystogram revealed no leakage from the urinary tract. An over-transfusion ascites was diagnosed combined with pulmonary edema. The patient was treated for 2 days in the ICU, until she was transferred to the orthopedic department with no signs of ascites.

Use of low-dose neostigmine intravenously in the treatment of supraventricular tachycardia: An immediate bradycardic effect

Neostigmine was first used 50 years ago to treat sinus tachycardia and paroxysmal auricular tachycardia. Then there were reports of successful treatment by neostigmine of other forms of supraventricular tachycardias. However, reports of sudden death using neostigmine for reversal of neuromuscular blockade at the end of an operation, which were not properly treated with atropine abandoned the use of neostigmine as an antiarrhythmic drug. Low-dose neostigmine intravenously was used in the treatment of supraventricular tachycardia in three patients described herein. It gave an immediate bradycardic effect in all three patients. The use of a low-dose neostigmine intravenously for an immediate treatment of supraventricular tachycardia is a novel suggestion. It has to be further evaluated and compared to the conventional drugs used like digoxin, verapamil, propranolol or esmolol.