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Biomedical subjects

B R Birch

Publications and source records attributed to B R Birch.

At least 37 records · Page 2Linked to original sources
PubMed1994

Walk-in, walk-out day case genito-scrotal surgery with sedation reversal. A survey of patient attitudes and morbidity.

OBJECTIVES: To survey patient attitudes and assess the extent of patient morbidity in the first 24 h following walk-in, walk-out day case genito-scrotal surgery with sedation reversal. PATIENTS AND METHODS: One hundred patients who were undergoing genito-scrotal surgery were eligible for inclusion in the study. All patients walked into theatre, positioned themselves on the operating table and were sedated with intravenous (i.v.) midazolam (Hypnovel, Roche Products Ltd, Welwyn, UK) following which the appropriate local anaesthetic block was performed. One minute before the end of surgery sedation was reversed with an i.v. injection of 0.5 mg flumazenil (Anexate, Roche Products Ltd). When conscious and alert (approx. 2 min), patients were allowed to get themselves up off the operating table and walk from theatre. All patients were given a questionnaire to complete and were reviewed 2 weeks after surgery. RESULTS: Eighty-six of 100 patients returned questionnaires. Fifty-five patients were asymptomatic and no patient experienced nausea or vomiting in the first 24 h post-operatively. Other symptoms such as headache (2%), drowsiness (20%) and dizziness (11%) were uncommon and significantly less frequent than seen with general anaesthetic procedures. Seventeen patients described minor wound complications and one patient with a scrotal haematoma was readmitted for overnight observation. Nearly all patients (98%) expressed their satisfaction with the technique. CONCLUSION: Walk-in, walk-out day case surgery as described is a well-tolerated technique with a low morbidity and towards which patients have a positive attitude.

Adolescent↗
PubMed1994

Absorption characteristics of lignocaine following intravesical instillation.

The systemic absorption of topical lignocaine applied intravesically was studied in 11 patients with indwelling catheters. Group A patients (n = 9) had lignocaine 400 mg (as 40 ml of a 1% solution) instilled into the bladder for 1 hour whilst in Group B patients (n = 2) the application was for 2 hours. The mean maximum lignocaine concentration measured in Group A patients was 121 ng ml-1 with a time to maximum concentration of 60-90 minutes. The two patients in Group B had corresponding values of 410 and 1580 ng ml-1 respectively at 120 minutes. Transitional cell epithelium, like intact skin, constitutes a significant barrier to the uptake of topically applied lignocaine which, from the bladder, is both slow and limited. Intravesical application is safe (maximum levels in Group A patients being x 30 less than the minimal toxic level of lignocaine) but its clinical efficacy remains to be determined.

Absorption↗
PubMed1991

Transurethral resection of prostate under sedation and local anesthesia (sedoanalgesia). Experience in 100 patients.

One hundred male patients (average age 68.2 yrs) with acute retention (n = 20) or with symptoms of outflow obstruction (n = 80) underwent transurethral resection of the prostate (TURP) under sedation (midazolam) and local anesthesia (lidocaine)--referred to as sedoanalgesia technique. Procedures lasted twenty-four minutes on average (range 15-35 min), and the weight of prostatic tissue resected ranged from 2-35 g (average 11.1 g). There were no complications related to the use of midazolam or lidocaine. The technique of sedoanalgesia proved safe and acceptable to all patients regardless of their pre-existing medical condition. Where the weight of prostate to be resected is estimated to be less than 40 g, TURP under sedoanalgesia proves an effective alternative to general or regional anesthesia.

Aged↗
PubMed1991

Evaluation of endothelial markers in detecting blood and lymphatic channel invasion in pT1 transitional carcinoma of bladder.

In a study of 40 patients with high-grade (G2 and G3) transitional cell carcinoma of bladder invading the lamina propria--stage pT1, retraction artifact was often misdiagnosed as vascular/lymphatic tumour invasion. Vascular/lymphatic infiltration was diagnosed in five cases based on haematoxylin and eosin stained sections, but confirmed in only two of these using immunohistochemical techniques to demonstrate endothelial markers. Of the latter, these preparations demonstrating von-Willebrand factor and binding the monoclonal antibody QBEND/10 were technically superior to those in which Ulex europaeus agglutinin 1 was used. It is unlikely that the demonstration of vascular/lymphatic infiltration, a rare feature, will prove of value in defining prognostic groups for treatment.

Antibodies↗
PubMed1991

Spontaneous external biliary fistula uncomplicated by gallstones.

External biliary fistulae are rare. Only 65 cases have been reported in the literature and in each instance gallstones were a complicating factor. We report in this paper the first case of spontaneous external (cholecystocutaneous) biliary fistula uncomplicated by gallstones.

Aged↗
PubMed1991

Sedation for day-case urology: an assessment of patient recovery profiles after midazolam and flumazenil.

The specific antagonist flumazenil has been shown to reverse the central actions of benzodiazepines. Its use, in day-case procedures performed under benzodiazepine sedation, offers the potential for enhanced patient recovery. However, concern has been expressed over the possibility of resedation given the short elimination half-life of flumazenil. A randomised, double-blind, placebo controlled trial was therefore designed to assess patient recovery profiles after flumazenil. A total of 44 adults were entered into the trial. Recovery was assessed by means of a battery of psychomotor tests performed pre- and postoperatively. Psychomotor function in patients receiving flumazenil returned to, or near to, baseline levels within 15 min of administration--an improvement maintained throughout the 6 h test period. Patients receiving placebo did not recover fully until the 2 h test point--significant differences between the two groups existing at 15 min and 1 h. In this study, flumazenil effectively reversed midazolam-induced sedation without evidence of resedation. The implications for day-case surgery are discussed.

Adult↗
PubMed1990

The role of midazolam and flumazenil in urology.

The effects of midazolam (3-10 mg i.m.) and their reversal by flumazenil were studied in transurethral endoscopic procedures performed using topical analgesia. In one randomised study, patients (n = 84) received either no medication or flumazenil (0.5 mg i.v.) on completion of endoscopy. Recovery was assessed subjectively. Within 15 min, 83% of those receiving flumazenil were considered ready for discharge compared with only 24% of the control group (P less than 0.001). In a second randomised, double-blind, placebo-controlled trial of 44 patients, post-operative recovery was assessed using five objective psychomotor tests. Whereas the placebo group took up to 2 h to recover, those receiving flumazenil recovered fully or returned to near control values within 15 min. Sedoanalgesia--a technique combining adequate local anaesthesia with sedation (using midazolam)--has wide application in urology, and the introduction of flumazenil has major implications for the practice of day-case surgery.

Adult↗
PubMed1990

Sedoanalgesia in urology: a safe, cost-effective alternative to general anaesthesia. A review of 1020 cases.

Sedoanalgesia is a technique developed to provide safe and satisfactory operating conditions for a wide range of patients independent of age and overall level of fitness (although its use in children remains to be established). It is suitable for both endoscopic and open procedures, day-cases and in-patients. When used in day-case surgery it significantly improves overall efficiency. It is recognised that day-case surgery is an important and cost-effective element in surgical care. With increasing restraints being imposed upon hospital finances, patient beds and staffing levels, any strategies designed to improve efficiency in this sphere of surgical activity are to be welcomed. That 93% of patients prefer sedoanalgesia to conventional general anaesthesia attests to its high degree of acceptability. The technique of sedoanalgesia, its applications and potential impact for urology are detailed.

Ambulatory Surgical Procedures↗
PubMed1990

Day-case surgery: enhanced recovery with flumazenil.

In an open, randomized, parallel group study of 84 adult patients undergoing elective day-case urological surgery the specific benzodiazepine antagonist flumazenil was shown to reverse effectively subjective postoperative sedation due to midazolam and enabled 83% of patients to recover and be ready for potential discharge within 15 min of surgery (control group 24% p less than 0.001). The significantly shorter recovery time has benefits in terms of increased patient cooperation and reduced demands on postoperative nursing care. The implications of these findings for day-case surgery are discussed.

Adult↗
PubMed1988

Tethered ureteric stents--a clinical assessment.

The acceptability and complications of tethered double-J stents were assessed in 17 patients. The study showed tethered ureteric stents to be safe, well tolerated and easy to remove. The technique avoids unnecessary ureteral instrumentation and general anaesthesia and has benefits for both patients and hospital resources.

Adolescent↗