Biomedical subjects
Publications and source records attributed to D A Rocke.
A case is reported in which percutaneous lung biopsy was followed by haemorrhage into the tracheobronchial tree. Hypoxia followed, precipitating a cardiac arrest. The haemorrhage was isolated by the insertion of a double-lumen tube. Complications arising from this method of biopsy are reviewed and the measures necessary to control the potentially fatal problems are discussed.
The cardiovascular instability in some cases of severe tetanus is due to increased circulating catecholamines. In 15 patients with this complication of tetanus, labetalol, a drug with alpha- and beta-peripheral adrenergic blocking properties, was used in management. The drug was administered orally, by i.v. bolus or by continuous infusion. Wide variation in dosage was needed both from case to case and in the same patient during the course of his disease. In most cases the pulse and blood pressure were reduced by labetalol, although their variability was not much improved. The effect on the cardiac output and systemic vascular resistance ranged from modest reduction in both, to marked effect on cardiac output without any change in systemic vascular resistance. The alpha-adrenergic blockage of labetalol is known to be less powerful than the beta-blocking effect, and this property could be a disadvantage in the management of sympathetic overactivity in tetanus.
A technique of total intravenous anaesthesia using etomidate by bolus intravenous (IV) injection for induction and by continuous intravenous infusion for maintenance of anaesthesia, with supplementary intravenous fentanyl analgesia, is described. Muscle relaxation was provided by competitive neuromuscular blockade, allowing controlled ventilation of the lungs with oxygen-enriched air. Arterial blood pressure, heart rate and rhythm remained stable throughout the procedure. Few complications were encountered of which the most significant was a 13% incidence of nausea and/or vomiting. Pain on injection, abnormal muscular movements on induction, and post operative venous sequelae were uncommon. Patients were easily rousable shortly after termination of drug infusion. The technique proved acceptable to the patient, surgeon and experienced anaesthetist and, thereby, would appear to offer a reasonable alternative to the more conventional inhalational anaesthetic technique.