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Biomedical subjects

A R Bodenham

Publications and source records attributed to A R Bodenham.

36 records · Page 2Linked to original sources
PubMed1996

Local anaesthesia to the airway reduces sedation requirements in patients undergoing artificial ventilation.

Patients in the intensive care unit require large doses of sedative/analgesic drugs to tolerate the presence of a tracheal tube and other unpleasant stimuli. The ideal regimen for sedatives and analgesics has not yet been found. We have investigated the effects of topical local anaesthesia to the pharynx and airway on sedative/analgesic requirements in 30 ICU patients (25-75 yr old) with no obvious brain injury, undergoing mechanical ventilation. Oral tracheal tubes were changed to a modified tube which allowed instillation of local anaesthetic solutions onto the pharyngeal, laryngeal and tracheal mucosa. Lignocaine 1% (5 ml) or 5 ml of 0.9% saline were instilled hourly for 12 h each for a total of 24 h, in a double-blind, randomized crossover design. Baseline sedation was maintained with propofol or alfentanil infusions, or both, which were titrated to patient comfort and to maintain an optimum sedation score throughout. Twenty-five patients completed the study. Mean total propofol and alfentanil requirements were 766 (SD 524) mg and 17 (7.6) mg, respectively, during 12 h of lignocaine instillation, and 1321 (862) mg and 25 (11.4) mg, respectively, during 12 h of saline instillation. There was a significant reduction (P < 0.05) in the requirements for both agents during the period of lignocaine instillation.

Adult↗
PubMed1996

Validation of use of whole-cell repetitive extragenic palindromic sequence-based PCR (REP-PCR) for typing strains belonging to the Acinetobacter calcoaceticus-Acinetobacter baumannii complex and application of the method to the investigation of a hospital outbreak.

Acinetobacter spp. are being reported with increasing frequency as causes of nosocomial infection. In order to identify reservoirs of infection as quickly as possible, a rapid typing method that can differentiate epidemic strains from environmental and nonepidemic strains is needed. In 1993, a cluster of Acinetobacter baumannii isolates from five patients in the adult intensive therapy unit of our tertiary-care teaching hospital led us to develop and optimize a rapid repetitive extragenic palindromic sequence-based PCR (REP-PCR) typing protocol for members of the Acinetobacter calcoaceticus-A. baumannii complex that uses boiled colonies and consensus primers aimed at repetitive extragenic palindromic sequences. Four of the five patient isolates gave the same REP-PCR typing pattern as isolates of A. baumannii obtained from the temperature probe of a Bennett humidifier; the fifth isolate had a unique profile. Disinfection of the probe with 70% ethanol, as recommended by the manufacturer, proved ineffective, as A. baumannii with the same REP-PCR pattern was isolated from it 10 days after cleaning, necessitating a change in our decontamination procedure. Results obtained with REP-PCR were subsequently confirmed by ribotyping. To evaluate the discriminatory power (D) of REP-PCR for typing members of the A. calcoaceticus-A. baumannii complex, compared with that of ribotyping, we have applied both methods to a collection of 85 strains that included representatives of six DNA groups within the complex. Ribotyping using EcoRI digests yielded 53 patterns (D = 0.98), whereas 68 different REP-PCR patterns were observed (D = 0.99). By computer-assisted analysis of gel images, 74 patterns were observed with REP-PCR (D = 1.0). Overall, REP-PCR typing proved to be slightly more discriminatory than ribotyping. Our results indicate that REP-PCR typing used boiled colonies is a simple, rapid, and effective means of typing members of the A. calcoaceticus-A. baumannii complex.

Acinetobacter↗
PubMed1995

An evaluation of a new percutaneous tracheostomy kit.

The Portex percutaneous trachestomy kit incorporates guidewire dilating forceps which pass over a guidewire and perform rapid dilatation. These forceps have curved jaws which are designed to reduce possible damage to the lateral and posterior walls of the trachea. The guidewire dilating forceps are first opened in front of the trachea to dilate the pretracheal tissues and then opened in the trachea to dilate the anterior tracheal wall. A tracheostomy tube is then passed over the guidewire and into the trachea. The procedure was rapid and successful in all 20 patients, with no serious complications. Mean time to perform tracheostomy was 4.9 min (range 90 s-15 min). Overall, the Portex percutaneous tracheostomy kit worked well and proved a rapid and acceptable method for performing percutaneous tracheostomy.

Adolescent↗
PubMed1993

Percutaneous tracheostomy.

Percutaneous dilational tracheostomy (PDT) originated in the USA and now an increasing number of UK centres are adopting the technique. It compares favourably with traditional surgical tracheostomy; PDT can be performed more satisfactorily at the bedside, avoiding the transport of critically ill patients to the operating theatre. It is a more rapid and convenient technique and evidence increasingly suggests that it is associated with significantly fewer and less severe complications. If early reports are confirmed by larger, carefully controlled trials, it is likely that PDT will largely replace conventional surgical techniques for the provision of tracheostomy in the critically ill. An improved risk-benefit ratio of PDT may favour earlier conversion of translaryngeal intubation to tracheostomy.

Female↗
PubMed1992

Advanced trauma life support. A time for reappraisal.

The experience of Advanced Trauma Life Support training received by three anaesthetists is discussed with particular reference to the teaching of airway management, the grade of staff who should attend the present courses and the relevance to the British hospital system. We conclude that these courses are useful but limited by their inflexibility and failure to recognise the difference in skill mix in the British setting.

Algorithms↗
PubMed1991

A comparison of dopexamine and dopamine to prevent renal impairment in patients undergoing orthotopic liver transplantation.

The efficacy of low-dose dopamine as a renal protective agent was compared with that of dopexamine in patients who underwent orthotopic liver transplantation. Twelve patients who received a continuous infusion of dopexamine (1-3 micrograms/kg/minute) were matched for age, diagnosis, pre-operative creatinine clearance and blood loss with 12 patients who received a low-dose infusion of dopamine (2 micrograms/kg/minute). The catecholamine infusion was started after induction of anaesthesia and continued for 48 hours after surgery. Patients in the dopexamine group had less evidence of renal impairment and failure than those in the dopamine group during 7 days after the operation, although the differences between groups did not achieve statistical significance. Similarly there were no significant differences between the two groups in peri-operative urine output, urine/plasma osmolality ratio or creatine clearance. Dopexamine is at least as effective as dopamine for renal protection in patients who undergo liver transplantation.

Acute Kidney Injury↗
PubMed1990

Analgesic efficacy of perioperative buccal morphine.

We have studied the effect of regular perioperative administration of buccal morphine sulphate on postoperative analgesic consumption in female patients undergoing lower abdominal surgical procedures. Ten matched pairs of women were allocated randomly to receive either placebo or buccal morphine before operation and at 12-h intervals up to 44 h after operation. Pain was assessed using a visual analogue scale and taste assessed using evaluation forms. Postoperative analgesic requirements were compared using a patient-controlled analgesia system which was set to deliver bolus doses of pethidine without a background infusion. There was no significant difference in pain scores between the two groups. Compared with placebo, buccal morphine did not reduce significantly postoperative pethidine consumption. All patients receiving buccal morphine reported a taste which reduced its acceptability.

Administration, Buccal↗
PubMed1990

Dopexamine: studies in the general intensive care unit and after liver transplantation.

1. It has been suggested that the use of dopaminergic agents in the critically ill patient may reduce the incidence of renal failure and hence mortality. 2. Dopexamine hydrochloride is a new synthetic catecholamine. Like dopamine, it stimulates dopaminergic receptors. It also stimulates beta 2-adrenoceptors. Unlike dopamine, dopexamine has minimal effect at beta 1-adrenoceptors and no alpha-adrenoceptor activity. 3. Stimulation of renal dopaminergic and beta 2-adrenoceptors independently results in dilation of the renal vasculature. A natriuresis and diuresis is also promoted by dopaminergic stimulation. 4. A comparison between the administration of low dose dopamine and dopexamine in patients undergoing orthotopic liver transplantation resulted in less renal impairment and failure in the dopexamine group, although this did not achieve statistical significance. 5. Dopexamine elimination is reduced in the absence of hepatic function. 6. A patient with terminal liver failure was treated with dopexamine and although oxygen delivery was unchanged, oxygen consumption doubled. This suggests that dopexamine affects other organs as well as the kidneys.

Critical Care↗
PubMed1989

Comparison of propofol and midazolam for sedation in critically ill patients.

101 critically ill patients admitted to five intensive-care units were allocated randomly to receive a continuous intravenous infusion of either propofol or midazolam for sedation for up to 24 h. In addition, morphine was given to provide analgesia. The mean duration of infusion was 20.2 h (range 3.0-24.5) in the propofol group and 21.3 h (4.0-47.0) in the midazolam group and infusion rates were 1.77 mg/kg/h (range 0.40-5.00) and 0.10 mg/kg/h (0.01-0.26), respectively. The infusion rates were adjusted as necessary, and the desired level of sedation was achieved easily in most patients in both groups. There were slight falls in arterial pressure, but there were no significant differences between the groups. Heart rate was lower in patients who received propofol. Some small changes occurred in biochemical and haematological variables in both groups, but they were not clinically significant. There was no indication that either drug substantially impaired adrenal steroidogenesis. When the infusion was discontinued, there was less variability in recovery of consciousness in patients who had received propofol. In a subgroup of patients, weaning from mechanical ventilation was achieved significantly faster after discontinuation of propofol than of midazolam. Propofol proved to be a satisfactory agent for sedation of these critically ill patients and compared favourably with midazolam.

Adolescent↗
PubMed1989

The pneuPAC ventilator with new patient valve and air compressors.

The pneuPAC Model 2-R pneumatic logic ventilator with a new air entrainment valve that offers the option of an FIO2 of 1.0 or 0.45 is described. Its robustness, portability, variable FIO2, choice of positive end expiratory pressure and pressure relief valves make it versatile and suitable for transporting critically ill patients, as well as for resuscitation use when adverse conditions may be encountered. Two new medical air compressors, one mains driven and the other battery powered, designed for use with the ventilator, are also described. The function of the ventilator with the new valve was assessed using a piped gas supply and then reassessed when powered by the compressors.

Equipment Design↗
PubMedDate not supplied

Percutaneous tracheostomy.

Elective tracheostomy is commonly performed on patients in intensive care units who require assisted ventilation for more than 1-2 weeks. Percutaneous dilatational techniques have recently been developed which allow tracheostomies to be performed at the bedside. These compare favourably with conventional techniques.

Contraindications↗
PubMedDate not supplied

Modified haemoglobins as oxygen-transporting blood substitutes.

Haemoglobin solutions have been developed as red cell substitutes from various sources, e.g. outdated human blood, and bovine and recombinant haemoglobins. Haemoglobins have been modified to reduce their high oxygen affinity, oncotic activity and to prolong their intravascular half-life. Aside from oxygen carriage, modified haemoglobin solutions have other interesting properties, including vasopressor effects and improvements in regional blood flow.

Animals↗