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Biomedical subjects

D A Jewkes

Publications and source records attributed to D A Jewkes.

10 recordsLinked to original sources
PubMed1995

Prophylaxis against thromboembolism in neurosurgical patients: a survey of current practice in the United Kingdom.

Venous thromboembolism is a life threatening, but preventable complication of major surgery. Many neurosurgical patients are at high risk of developing thromboembolic disease. A postal survey was undertaken of 44 UK neurosurgical centres to assess the use of physical and pharmacological methods of prophylaxis against thromboembolism. Thirty-five replies were received from 31 centres. Seventy-seven per cent of units used antiembolism stockings (TEDs) for elective surgery and 37% for emergency surgery; in approximately two-thirds of these units TEDs constituted the sole method of prophylaxis used during both elective and emergency surgery. Intermittent pneumatic compression (IPC) was utilized in 37 and 11% of units for elective and emergency surgery, respectively. Subcutaneous heparin was used in 32% of units perioperatively including 6% of emergency cases. These findings suggest that neurosurgical patients, who are at moderate to high risk of developing thromboembolic complications, may not receive effective prophylaxis; those undergoing emergency neurosurgery are less likely to receive any form of prophylaxis.

Brain↗
PubMed1990

Midazolam and flumazenil in the anaesthetic management of trigeminal nerve thermocoagulation.

A technique is described for the anaesthetic management of trigeminal nerve thermocoagulation by administration of repeated doses of midazolam and flumazenil. "Wake-up" times after administration of flumazenil in 20 patients were shorter than those reported during spontaneous recovery from methohexitone or propofol anaesthesia. The midazolam dose required for a second phase of sedation after antagonism of the first with flumazenil was significantly less than that for the first phase of sedation. There was no evidence of postoperative resedation. Reversal of sedation was associated with an increase in arterial pressure.

Alfentanil↗
PubMed1990

Postoperative paraplegia in a patient with an unsuspected dural arterio-venous malformation.

We report a case in which laminectomy was performed in a patient with symptoms attributed to lumbar canal stenosis. The patient developed paraplegia in the early postoperative period. Further investigation revealed a dural arterio-venous malformation. This was treated surgically, producing some neurological recovery. The possible mechanisms for the perioperative deterioration and their implications for anaesthesia are discussed.

Arteriovenous Malformations↗
PubMed1990

Anaesthesia for simultaneous caesarean section and clipping of intracerebral aneurysm.

A 38-yr-old woman who was 35 weeks pregnant presented with a subarachnoid haemorrhage, secondary to a ruptured anterior communicating artery aneurysm. Following initial recovery, she subsequently underwent simultaneous elective Caesarean section and clipping of the aneurysm. The anaesthetic management of the case is described and discussed.

Adult↗
PubMed1990

Double-blind comparison of topical lignocaine-prilocaine cream (EMLA) and lignocaine infiltration for arterial cannulation in adults.

In a double-blind, double-dummy study, the efficacy of topical 5% EMLA cream was compared with that of lignocaine infiltration in alleviating the pain of arterial cannulation. Forty unpremedicated adults were allocated randomly to four groups to receive EMLA cream alone, EMLA and 0.9% saline infiltration, EMLA and 1% lignocaine infiltration or placebo cream and 1% lignocaine infiltration. Following arterial cannulation, pain was assessed by the patient using a visual analogue score and by an independent observer using a four-category verbal rating score. Significantly lower pain scores were observed in all patients receiving EMLA compared with those receiving placebo cream and lignocaine infiltration by both patient (P less than 0.01) and observer (P less than 0.001) assessments. There were no significant differences between the three EMLA groups.

Administration, Topical↗