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Biomedical subjects

D C Galletly

Publications and source records attributed to D C Galletly.

At least 73 records · Page 4Linked to original sources
PubMed1990

Flumazenil: a twelve-month survey of use in a New Zealand public hospital.

As part of a program of postmarketing surveillance, the use of flumazenil was monitored prospectively in a New Zealand public hospital for a period of twelve months. A questionnaire on usage, efficacy and side-effects was completed by clinicians for 118 patients receiving the drug. Our conclusions are these: 1. Flumazenil was used most frequently after anaesthesia and in the initial management of intentional drug overdose. 2. In two-thirds of cases, flumazenil was used to antagonise benzodiazepines in the presence of non-benzodiazepine drugs and its efficacy was primarily determined by the presence of these latter drugs. 3. The complications of flumazenil are mild although important complications may arise from interaction with other drugs and unmasking of conditions such as postoperative pain. 4. Resedation was common (24%), although rarely a problem unless large doses of benzodiazepine agonist had been administered or if other hypnosedatives were given subsequently.

Adult↗
PubMed1990

A comparison of intravenous cannulae available in New Zealand.

This study examined physical and clinical features of eleven models of disposable intravenous cannulae available in New Zealand: Angiocath, Braunule, Insyte, Jelco, J.M.S., Medicut, Nipro, Quikcath, Surflo, Venflon and Wallace. Dimensions of external and internal diameter and wall thickness varied greatly among the models of the same gauge size. As a result, flow rates also varied greatly, but linearly with internal diameter. Anaesthetists were randomly given a range of 16 and 22 gauge cannulae for routine clinical use (forty of each model) and completed a questionnaire on features of cannula performance relating to success of cannulation, ease of insertion, ease of handling, kinking, and packaging. The results of this questionnaire are presented and discussed. The 22 gauge cannula tips were assessed microscopically for distortion after clinical use. Jelco cannulae were found to have the highest incidence of catheter tip distortion (54%).

Adult↗
PubMed1989

Resuscitation skills of first year postgraduate doctors.

The resuscitation skills of twenty seven doctors in their preregistration year were examined using a series of mock clinical scenarios and theoretical testing. All failed to reach basic life support standards of the American Heart Association and major deficiencies were revealed in the provision of ventilatory support, pharmacological therapy and the use of resuscitation equipment. Specific educational deficiencies that were apparent included: (1) early initial training without subsequent revision or testing; (2) the inadequate gaining of practical skills and equipment familiarity during the trainee intern and first year house officer years; and (3) an ill defined curriculum of emergency care that was fragmented between specialties and between lay and medical teachers.

Arrhythmias, Cardiac↗
PubMed1989

Patient-administered anxiolysis--a pilot study.

The feasibility of self-premedication with intravenous diazepam was examined in an open study of 50 preoperative patients. Using a Bard 'Harvard PCA' patient-controlled analgesia system, patients were instructed to deliver the drug in a dose sufficient to remove their anxiety for the scheduled surgical procedure. Aliquots of diazepam 2 mg were delivered on demand up to a total dose of 20 mg over a 30 minute premedication period. The mean dose administered was 8.1 mg (range 0-16 mg) producing a highly significant reduction in both patient- and anaesthetist-assessed anxiety rating. Neither the patient's sex nor the nature of the surgical procedure influenced the dose administered. Although poor, the best predictor of self-premedicating dose was patient's own preoperative anxiety rating with the anaesthetist's assessment of patient anxiety not correlating with the dose administered. No patient was considered excessively sedated by the premedication. Patient-administered anxiolysis is suggested as a useful research tool in the examination of anxiety and of value in premedicating patients with high preoperative anxiety levels.

Adult↗
PubMed1989

Double-blind comparison of midazolam and temazepam as oral premedicants for outpatient anaesthesia.

Oral premedication with midazolam 7.5 mg was compared with temazepam 20 mg in a double-blind study of sixty patients undergoing day-stay urological surgery. One hour following ingestion similar degrees of anxiolysis and sedation were reported by patients for both compounds. However, midazolam was observed by anaesthetists to produce the greater anxiolytic effect and was given the better overall assessment. Midazolam produced significantly greater amnesia both at the time of induction and 30 minutes postoperatively. At the time of discharge four hours postoperatively no significant difference could be observed in psychomotor performance or subjective sedation although on the evening of surgery the temazepam group had a greater incidence of sleepiness and an earlier time to retiring. Although the differences were small, the residual post-discharge effects of temazepam lead us to conclude that midazolam 7.5 mg is the more suitable premedicant for outpatient use.

Adult↗
PubMed1989

Residual psychomotor effects following reversal of midazolam sedation with flumazenil.

The ability of flumazenil to reverse the effects of midazolam sedation was examined in a randomised, crossover, placebo controlled study in six male volunteers. Subjects received intravenous injections of either (a) midazolam 10 mg followed 10 minutes later by flumazenil 1.0 mg or (b) midazolam 10 mg followed after 10 minutes by flumazenil 4 mg or (c) placebo followed after 10 minutes by placebo. Post reversal drug effects were examined using a psychomotor battery (critical flicker fusion, digit symbol substitution, tapping test, ball-bearing test, number recall, reflex time) and linear analogue mood scales. It was found that a residual psychomotor deficit was present following flumazenil and that this persisted for up to 125 minutes after the 1.0 mg dose and 65 minutes following 4 mg. A small deterioration in performance was apparent after initial reversal with 1.0 mg, the peak deterioration occurring at 35 minutes.

Adult↗
PubMed1988

Total intravenous anaesthesia using propofol infusion--50 consecutive cases.

Fifty consecutive patients in the authors' practice were anaesthetised with a total intravenous technique using propofol infusion, fentanyl, vecuronium and oxygen in air. Patients were predominantly elderly and undergoing major upper gastrointestinal surgery for a mean duration of 133 minutes (range 20 minutes to 7 hours). Twenty-one patients had significant concomitant medical illness. Propofol was found to give a rapid, smooth induction with wide variation in dose requirement (0.5 to 2.9 mg/kg). There was a mean systolic blood pressure fall of 27% from preoperative values, greatest in elderly patients. Depth of anaesthesia was readily adjusted by alteration in infusion rate according to standard clinical criteria. The dose of propofol required for maintenance was highly variable (range 2-15 mg/kg/hr in the first hour). Three patients reported dreaming and two of these had shown signs of light anaesthesia. Recovery was rapid, with few side-effects, and a mean time to open eyes on command of 8.5 minutes from the end of infusion. Propofol was considered to be a satisfactory intravenous agent for the induction and maintenance of anaesthesia in the majority of patients studied. The most significant problem was hypotension following the induction dose.

Adolescent↗
PubMed1988

A double-blind comparative study of three formulations of diazepam in volunteers.

The sedation and subsequent recovery following administration of three formulations of diazepam (propylene glycol, mixed micelle and lipid emulsion) were compared in a randomised, double-blind, crossover study of twelve male volunteers. Following intravenous injections of 10 mg of each formulation, sedation was assessed for ten minutes using a six-point ordinal sedation score and subsequent recovery was assessed using a psychomotor/sedation battery including simple reflex time, letter deletion test, a simple arithmetic exercise, digit recall and a linear analogue sedation scale. Diazepam in propylene glycol was found to be more sedating that diazepam, either in a lipid formulation or as mixed micelles and appeared faster in its rise to peak effect than the lipid formulation. Subsequent recovery did not differ between the three groups. A significant increase in the level of sedation achieved by the preparations was found with each study day indicating that subject or testing factors were also important in determining the sedative response. Our results suggest that the new solvent systems, and in particular the lipid emulsion, primarily alter initial drug efficacy.

Adult↗
PubMed1987

Placebo controlled comparison of midazolam, triazolam and diazepam as oral premedicants for outpatient anaesthesia.

Two short-acting benzodiazepines, midazolam 15 mg and triazolam 0.25 mg, were compared with diazepam 10 mg and placebo as oral premedicants in 120 patients presenting for minor urological surgery. Midazolam was found to produce the greatest degree of amnesia and sedation at the time of anaesthetic induction and triazolam was found to have the greatest degree of residual sedation at the time of discharge, four hours postoperatively. These effects are consistent with the greater potency and more rapid onset of action of midazolam at this dose compared with triazolam. The relative merits of the compounds as anxiolytics varied depending upon the observer, time and method of assessment. It was considered that the doses of midazolam and triazolam used were excessive for routine day case anaesthesia.

Administration, Oral↗
PubMed1987

Comparison of propofol and antagonised midazolam anaesthesia for day-case surgery.

A technique of midazolam/fentanyl/isoflurane/nitrous oxide anaesthesia, in which the benzodiazepine was antagonised by the specific antagonist, flumazenil, was compared with propofol/fentanyl/nitrous oxide anaesthesia for minor outpatient urological surgery. No significant difference was found in the overall ease of anaesthesia; however, using subjective (linear analogue sedation scales) and objective (letter deletion and simple reflex time) tests, recovery was found to be significantly slower for the antagonised midazolam group. For both groups, the most frequent intraoperative problem was patient movement in response to surgical stimulation and, postoperatively, headache. The midazolam group displayed the greatest degree of residual sedation at the 4-hour time of discharge and on arrival home a significantly larger number of patients in the midazolam group slept for a period. It is likely that the dose of flumazenil chosen (1 mg) was inadequate to completely antagonise the dose of midazolam (mean 17 mg) for the full duration of recovery.

Adult↗
PubMed1986

Comparative cutaneous histamine release by neuromuscular blocking agents.

Normal values of cutaneous wheal diameter following intradermal injection of six neuromuscular blocking drugs were determined. The relative cutaneous histamine-releasing ability of each drug was derived from calculated dose-response relationships. Equipotent neuromuscular blocking doses were found to have a cutaneous histamine releasing ability relative to pancuronium (= 1) of vecuronium 1.1: suxamethonium 1.7; alcuronium 5; atracurium 52; d-tubocurarine 172. A significant (P less than 0.001) variation was found between the dose-response slopes perhaps suggesting a variation in the mechanism of histamine release.

Alcuronium↗
PubMed1985

Cutaneous sensitivity to atracurium and vecuronium in patients suffering anaphylactoid reactions to neuromuscular blockers.

Using an ordinal measure of cutaneous sensitivity to intradermal injections of atracurium and vecuronium, 40 nonreacting subjects were compared with a group of 24 patients previously suffering life-threatening anaphylactoid reactions to other muscle relaxants. Enhanced cutaneous sensitivity to vecuronium was found in three, and to atracurium in two of the previously reacting group. With the exception of those showing abnormal reactivity, no significant difference was found in the distribution of cutaneous sensitivity in the control and reacting group. A concentration of vecuronium 8.75 times that of atracurium was required to produce an equivalent intradermal wheal response.

Anaphylaxis↗
PubMed1985

Diazepam mixed micelle--comparison with diazepam in propylene glycol and midazolam.

A mixed micelle formulation of diazepam was compared with midazolam and diazepam in propylene glycol for evidence of venous intolerance following IV injection. The overall incidence of venous morbidity was 17% for diazepam mixed micelle, 26% for midazolam and 90% for diazepam in propylene glycol. Diazepam mixed micelle is suggested as a preferable alternative to the standard formulation.

Benzodiazepines↗
PubMed1985

Recovery from day-stay anaesthesia--a comparison of an intravenous and inhalational technique of maintenance.

In 60 patients undergoing minor day-stay surgical procedures, a standard inhalational technique of anaesthetic maintenance (halothane/nitrous oxide/oxygen) was compared with incremental dose methohexitone supplemented by nitrous oxide/oxygen. The methohexitone group showed faster immediate recovery but slower overall recovery at four hours. No difference was found in the incidence of minor sequelae up to 24 hours after anaesthesia.

Adult↗
PubMed1985

Anaphylactoid reactions during anaesthesia. Seven years' experience of intradermal testing.

Sixty one patients who had suffered intra-operative anaphylactoid reactions were studied. Intradermal testing identified the causative agent in 84% of cases and, in 75% of these, muscle relaxants were responsible. Predisposing factors in patients sensitive to muscle relaxants were: female sex, previous allergy and atopy. The incidence of previous exposure was considerably higher than that reported in the literature. Pancuronium is suggested to be the least likely currently available agent to provoke a major anaphylactoid reaction.

Adolescent↗