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Biomedical subjects

A R Bodenham

Publications and source records attributed to A R Bodenham.

At least 19 recordsLinked to original sources
PubMed2006

The carina as a radiological landmark for central venous catheter tip position.

BACKGROUND: Many publications, including the instructions accompanying central venous catheters, state that it is negligent to site the catheter tip in the right atrium. If the catheter tip is above the carina on a post-procedure radiograph then it is generally accepted that the catheter lies outside the right atrium. It is also recommended that the catheter tip should lie in the long axis of the superior vena cava without acute abutment to the vein wall. We performed a retrospective audit of the position of central venous catheter tips on routine post-procedure chest radiographs in intensive care unit patients, to see if these potentially conflicting requirements had been met. METHODS: We identified 213 central venous catheters suitable for analysis, within a study population of 200 consecutive cases. We measured the distance of the central venous catheter tip above or below the carina and the angle of the central venous catheter tip to the vertical (a surrogate marker for the angle of abutment of the tip to the approximately vertical superior vena cava wall). RESULTS: For right-sided catheters there was a high (74/163) number placed with their tips below the carina, but a very low number (4/163) with their tips at a steep (>40 degrees ) angle to the vertical. For left-sided catheters very few (7/50) were placed with their tips below the carina, but for those 43 sited above the carina most could be considered to be in suboptimal positions. This was because they were either too high and had not even crossed the midline (9), or had an acute angle (>40 degrees ) between the tip and the vertical (27). CONCLUSIONS: We suggest that for left-sided catheters placement of the tip below the carina is more likely to result in a satisfactory placement.

Adult↗
PubMed2006

Visualisation of needle position using ultrasonography.

Anaesthetists and intensivists spend a considerable proportion of their working time inserting needles and catheters into patients. In order to access deeper structures like central veins and nerves, they have traditionally relied on surface markings to guide the needle into the correct position. However, patients may present challenges due to anatomical abnormalities and size. Irrespective of the skill of the operator, there is the ever-present risk of needle misplacement with the potential of damage to structures like arteries, nerve bundles and pleura. Repeated attempts, even if ultimately successful, cause patient suffering and probably increase the risk of infection and other long term complications. Portable and affordable, high-resolution ultrasound scanners, has accelerated the interest in the use of ultrasound guidance for interventional procedures. Ultrasound guidance offers several advantages including a greater likelihood of success, fewer complications and less time spent on the procedure. Even if the target structure is identified correctly there is still the challenge to place the needle or other devices in the optimum site. The smaller and deeper the target, the greater the challenge and potential usefulness of ultrasound guidance. As a result of limited training in the use of ultrasound we believe that many clinicians fail to use it to its full potential. A lack of understanding, with regard to imaging the location of the needle tip remains a major obstacle. Needle visualisation and related topics form the basis for this review.

Acoustics↗
PubMed2005

A review of an anaesthetic led vascular access list.

The demand for insertion of long-term central venous (Hickman type) catheters is thought to be increasing. Organisation is required to meet this demand in a safe and efficient manner. This report reviews the results from a dedicated, anaesthetic led vascular access list over the initial 61-month period. One thousand procedures were performed. Nine hundred and twenty catheters were inserted under local anaesthesia, with or without intravenous sedation and analgesia. Eighty catheters were removed. All procedures were performed during a dedicated once weekly, morning list. A total of 53% of all procedures were performed on a day-case basis, 43% on in-patients. Only 1.5% of patients required an unexpected overnight stay (usually medically unfit patients). There were 81 (9%) cancellations on the day of procedure due to neutropaenia, pneumonia or urinary tract infections. Ultrasound guidance was used initially selectively in 14%, latterly in 100% of procedures and fluoroscopy in all insertions to confirm or adjust catheter position. This service has been well received by patients and oncology services. In addition it provides an interesting area of practice for anaesthetists and an ideal environment for teaching more advanced aspects of central venous access. It may provide a template of service for other centres.

Aged↗
PubMed2005

Percutaneous cervical pharyngostomy: a traditional technique revisited.

Enteral tube feeding is widely used in intensive care units, high dependency units and general wards. In some patients, an adequate intake is not maintained because patients cannot tolerate the tube. Insertion of an enteral feeding tube via a pharyngostomy is simple and potentially more easily tolerated. We describe our experience with three critically ill patients, using disposable vascular access equipment and a dilational technique. All three patients received markedly increased nutrition, but one patient suffered haemorrhagic complications.

Aged↗
PubMed2004

Ultrasound-guided infraclavicular axillary vein cannulation for central venous access.

BACKGROUND: Infraclavicular axillary vein cannulation is not commonly used for central venous access because identifying the surface landmarks is difficult. Ultrasound guided axillary vein puncture has not been well described. We assessed ultrasound imaging to guide catheterization of the infraclavicular axillary vein. METHODS: In 200 consecutive patients we attempted to catheterize the axillary vein using ultrasound imaging. After successful venepuncture, a tunnelled Hickman line was inserted for long-term central venous access. Surface landmarks of the skin puncture site were measured below the clavicle. We measured the depth of the vein from the skin, the length of the guidewire from skin to carina and the final length of catheter that was inserted. RESULTS: The axillary vein was successfully punctured with the help of ultrasound imaging with first needle pass in 76% of patients. The axillary vein was catheterized successfully in 96% of the cases. Guidewire malposition was detected and corrected by fluoroscopy in 15% of cases. Complications included axillary artery puncture in three (1.5%) and transient neuralgia in two (1%) cases. CONCLUSION: Ultrasound-guided catheterization of the infraclavicular axillary vein is a useful alternative technique for central venous cannulation with few complications.

Adolescent↗
PubMed2003

Disorders of the lymph circulation: their relevance to anaesthesia and intensive care.

The lymphatic system is known to perform three major functions in the body: drainage of excess interstitial fluid and proteins back to the systemic circulation; regulation of immune responses by both cellular and humoral mechanisms; and absorption of lipids from the intestine. Lymphatic disorders are seen following malignancy, congenital malformations, thoracic and abdominal surgery, trauma, and infectious diseases. They can occasionally cause mortality, and frequently morbidity and cosmetic disfiguration. Many lymphatic disorders are encountered in the operating theatre and critical care settings. Disorders of the lymphatic circulation relevant to anaesthesia and intensive care medicine are discussed in this review.

Anesthesia↗
PubMed1999

Urine colour as an index of hydration in critically ill patients.

In order to test the hypothesis that urine colour can be used as an index of hydration in critically ill patients, we selected 40 intensive care and high-dependency patients and correlated urine colour (scored on an eight-point scale) with various indices of hydration: urine:plasma sodium, osmolality and urea ratios, urine output and central venous pressure. In addition, we compared the colour-chart score with scores made by intensive care nurses (without the benefit of a colour chart) in order to test subjective assessment of urine colour. There were weak but statistically significant correlations between urine colour and urine output (Spearman's r = - 0.555) and between urine colour and urine:plasma sodium ratio (Spearman's r = - 0.459). Subjective assessment of urine colour appeared to be reliable. Thus, although urine colour does vary with hydration in the critically ill, assessment of urine colour adds little to the overall assessment of hydration in this group of patients.

Adolescent↗
PubMed1999

Carotid endarterectomy under local anaesthesia.

Carotid endarterectomy has been widely used for the surgical treatment of carotid stenosis, and may be performed under either general or local anaesthesia. This article examines the relative merits of both techniques for carotid endarterectomy, and describes the local anaesthetic technique used by the authors for this procedure.

Anesthesia, General↗
PubMed1998

Use of the Combitube for airway maintenance during percutaneous dilatational tracheostomy.

The Combitube airway allows short-term ventilation during cardiopulmonary resuscitation and can be useful in the management of the difficult airway. In a prospective observational study we assessed its use during percutaneous dilatational tracheostomy (PDT). Twenty-one intensive care patients scheduled for elective PDT had their tracheal tube replaced by a Combitube airway retaining the same ventilator settings. Arterial blood gases, airway pressures, SpO2 and end-tidal CO2 were measured as were the transmural pressures exerted by the Combitube cuffs. Combitube placement was successful in 20 of 21 patients although adequate ventilation was possible in only 17 (85%). There was no significant change in PaO2, SpO2, end-tidal CO2, Paco2 or mean airway pressure during Combitube ventilation. A high mean (SD) transmural pressure of 14.7 (5) kPa was exerted by the distal cuff. The Combitube provided a satisfactory alternative airway to the tracheal tube during performance of PDT in 85% of our patients. Potential problems associated with its use in intensive care patients are outlined.

Dilatation↗
PubMed1998

Peribulbar anaesthesia using a mixture of local anaesthetic and vecuronium.

The aim of this double-blind, randomised study was to assess the effects of the addition of 0.5 mg of vecuronium bromide to a standard local anaesthetic mixture used for peribulbar anaesthesia. We studied 60 patients undergoing regional anaesthesia for intra-ocular surgery and were primarily interested in the quality of globe and lid akinesia. All received a mixture of 5 ml 2% lignocaine with 1:200,000 adrenaline, 5 ml 0.75% bupivacaine and 150 IU hyaluronidase with either 0.9% saline 0.25 ml (group A, n = 30) or vecuronium bromide 0.25 ml (0.5 mg) (group B, n = 30). Eye movements assessed at both 5 and 10 min were significantly reduced in the vecuronium group (group B) (p < 0.05). We conclude that the addition of vecuronium at a dose of 0.5 mg to the standard local anaesthetic mixture improves the quality of globe and lid akinesia.

Aged↗
PubMed1997

A review of the management of abdominal aortic aneurysms in patients following cardiac transplantation.

OBJECTIVES: To describe the presentation, preoperative assessment and postoperative management of patients presenting with an infrarenal abdominal aortic aneurysm following a previous cardiac transplant. METHODS: The case histories of three patients have been examined and a literature review performed. CONCLUSIONS: The majority of patients developing aortic aneurysms had undergone cardiac transplantation for ischaemic cardiomyopathy and thus require detailed assessment of cardiac function preoperatively to exclude accelerated coronary artery disease in the graft. Full invasive cardiac monitoring during surgery is mandatory to maintain haemodynamic stability in patients with a dennervated heart and to avoid postoperative renal failure. The higher incidence of pulmonary and wound complications are discussed, together with protocols for maintaining adequate immunosuppression. Finally, data supporting a higher prevalence and more rapid expansion of aortic aneurysms in immunosuppressed patients is considered and evidence-based recommendations made regarding aneurysm screening in these patients.

Adult↗
PubMed1997

Initial evaluation of diaspirin cross-linked hemoglobin (DCLHb) as a vasopressor in critically ill patients.

OBJECTIVE: To evaluate the hemodynamic effects and any toxicologic effects of diaspirin cross-linked hemoglobin (DCLHb) in critically ill patients. DESIGN: A prospective, observational study. SETTING: A seven-bed intensive care unit (ICU) in a University teaching hospital. PATIENTS: Fourteen critically ill patients requiring vasopressor therapy to maintain adequate mean arterial pressure (MAP). All patients had secondary organ dysfunction. INTERVENTIONS: Administration of 100 mL boluses of 10% diaspirin cross-linked hemoglobin, up to a maximum of 500 mL, given over 15 mins and separated by 60 to 90 mins. MEASUREMENTS AND MAIN RESULTS: Hemodynamic parameters, norepinephrine and inotropic requirements, arterial and mixed venous blood gases, urine output, and biochemical and hematologic analyses were measured before diaspirin cross-linked hemoglobin administration and at multiple time points up to 72 hrs. MAP was maintained at approximately preinfusion values and the reduction in norepinephrine requirements was used as the main end point to assess the efficacy of diaspirin cross-linked hemoglobin as a vasopressor. Diaspirin cross-linked hemoglobin demonstrated a marked vasopressor action, allowing norepinephrine requirements to be reduced from 0.29 +/- 0.15 (SD) microgram/kg/min to 0.15 +/- 0.14 and 0.07 +/- 0.10 microgram/kg/min after the first (at 1.5 hrs, p < .001) and last (at 7.5 hrs, p < .0001) boluses, respectively. These reductions in norepinephrine requirements were maintained at 24, 48, and 72 hrs (p < .01 at all time points). These hemodynamic changes began within 5 mins of starting the diaspirin cross-linked hemoglobin infusion. MAP, heart rate, central venous pressure, pulmonary artery occlusion pressure, mean pulmonary arterial pressure (MPAP), systemic vascular resistance index, and urine output did not demonstrate any significant changes from preinfusion values. Pulmonary vascular resistance index increased at 7.5 hrs despite nonsignificant increases in MPAP. Cardiac index and oxygen delivery index decreased significantly at 7.5 hrs and 24 hrs. Total plasma bilirubin increased significantly from baseline at 24 and 48 hrs, before returning to baseline values within 5 days. Platelet count was significantly reduced at 6 and 24 hrs. No other biochemical or hematologic analyses were altered significantly post diaspirin cross-linked hemoglobin. CONCLUSIONS: This preliminary study demonstrated that diaspirin cross-linked hemoglobin is a potent vasopressor agent in critically ill patients with septicemic shock or systemic inflammatory response syndrome. This vasopressor characteristic of diaspirin cross-linked hemoglobin may have future clinical applications.

Adult↗
PubMed1997

MDMA induced hyperthermia: a survivor with an initial body temperature of 42.9 degrees C.

A young male survived hyperpyrexia (42.9 degrees C) following MDMA ("Ecstasy") ingestion. He developed convulsions, rhabdomyolysis, metabolic acidosis, and respiratory failure. This was successfully managed by assisted ventilation, aggressive fluid therapy, and the early administration of dantrolene, in addition to cooling measures. This is the first report of a survivor with such a severe hyperpyrexia.

Adult↗