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Biomedical subjects

D M Linton

Publications and source records attributed to D M Linton.

44 records · Page 3Linked to original sources
PubMed1984

Peri-operative management and administration of anaesthesia in children with congenital complete heart block. A case report and review.

The clinical presentation and natural history of congenital complete heart block (CHB) differ from those of acquired third-degree heart block. Although perioperative prophylactic cardiac pacing is considered mandatory in patients with acquired CHB, it is not usually necessary in children with asymptomatic congenital heart block. The anaesthetist should be able to identify which patients require temporary perioperative pacing, and should modify his anaesthetic technique appropriately for patients who do not. An 8-year-old patient with congenital CHB who required emergency surgery for acute appendicitis is presented and the anaesthetic management, including the indications for pacing, is discussed.

Anesthesia, General↗
PubMed1983

Central venous catheterization for parenteral nutrition. Experience at Groote Schuur Hospital.

The aim of this study was to determine the incidence of complications of catheterization for total parenteral nutrition (TPN) in patients of the Parenteral Nutrition Unit of Groote Schuur Hospital. During the 2-year study period, 218 central venous catheters were inserted in 170 patients. The preferred technique of percutaneous infraclavicular subclavian venepuncture with subsequent subcutaneous tunnelling using a silicone elastomere catheter is described. The incidence of major complications of catheter insertion was 4,5% (pneumothorax 4, subclavian artery puncture 6). There was a 2,7% incidence of catheter malpositioning (requiring repositioning) at initial insertion. The mean duration of catheterization was 12,9 days. During this period there was a 6,9% incidence of mechanical complications (occluded lines 13, extravascular infusion 2). Catheter-related sepsis was suspected in 37 cases (16,9%) and all these catheters were removed, but in only 7 cases (3,2%) was the sepsis proved to be catheter-related. There was no correlation between the duration of catheterization and the development of catheter-related sepsis. Furthermore, there was no increase in the incidence of catheter sepsis in patients with sepsis before catheterization.

Catheterization↗
PubMed1983

Etomidate as a rectal induction agent. Part I. A preliminary study in rats.

Etomidate (Hypnomidate; Janssen) 1,25% in sterile water was given rectally on 100 occasions to 50 male Long-Evans rats in doses ranging from 4 mg/kg to 12 mg/kg. The onset and duration of ataxia and hypnosis (i.e. loss of righting ability) were recorded. Ataxia was observed in all rats, even at the lowest dose levels. The lowest hypnotic dose was 6 mg/kg, when 2 out of 5 rats lost their righting ability. In all 50 rats given 8 mg/kg or more hypnosis occurred within 4 minutes (range 2-4 minutes, average 3,3 minutes), from which they recovered within an average of 10,4 minutes. The duration of hypnosis and time to full recovery from ataxia were dose-dependent. The rectal hypnotic dose of etomidate in rats has been found to be approximately ten times the documented intravenous dose. No mortality was recorded despite the rectal administration of ten times the intravenous lethal dose (LD50) for rats. Histological examination of the rectal and colonic mucosa showed that etomidate 1,25% in sterile water (pH 3,5) caused no significant mucosal change, but undiluted etomidate 12,5% (pH 1,8) caused haemorrhagic necrosis. We conclude that rectal etomidate 1,25% in sterile water is an efficient, predictable, evanescent and safe method of inducing anaesthesia in rats and warrants further investigation in clinical anaesthesia in children.

Anesthesia, Rectal↗
PubMed1983

Etomidate as a rectal induction agent. Part II. A clinical study in children.

Following the preliminary study in rats, etomidate (Hypnomidate; Janssen) 1,25% in sterile water (pH 3,5) was administered rectally to 40 children aged between 6 months and 5 years to induce general anaesthesia for scheduled minor surgical procedures. The doses given ranged from 3,0 mg/kg to 6,5 mg/kg. The time taken for hypnosis to occur and the incidence of muscle movements were recorded. Cardiovascular and respiratory parameters were monitored. Anaesthesia was maintained with nitrous oxide/oxygen and halothane as needed. The time taken for recovery from anaesthesia was recorded and the children were observed for 24 hours postoperatively. The lowest hypnotic dose was 4,5 mg/kg, when 2 out of 5 children fell asleep. In all children given 6,5 mg/kg hypnosis occurred within 4 minutes. Cardiovascular and respiratory parameters were stable. There did not appear to be any delay in the recovery of the children from inhalational anaesthesia. There was no clinical evidence of irritation of the rectal mucosa by the etomidate solution. This study shows that rectal administration of etomidate 1,25% in sterile water at a dose of approximately 20 times the recommended intravenous dose in children produces a rapid, predictable onset of hypnosis within 4 minutes and allows rapid recovery. This is highly suitable for outpatient anaesthesia in unpremedicated children who will accept neither inhalational nor intravenous induction.

Anesthesia, Rectal↗
PubMed1983

Comparison of methohexitone and etomidate for general anaesthesia in unpremedicated outpatients.

This study compares methohexitone (Brietal; Eli Lilly) and etomidate (Hypnomidate; Janssen) as hypnotic agents for the induction and maintenance of general anaesthesia in outpatients given fentanyl and nitrous oxide for analgesia but no premedication. While both agents provided suitable anaesthesia with a minimal incidence of side-effects, 66% of the patients who received methohexitone were noticeably drowsy 2 hours after the operation, whereas all but 3% of the patients who received etomidate were wide awake.

Adolescent↗
PubMed1982

Conservative management of blunt chest trauma.

Conservative management of blunt chest trauma reduces morbidity in selected patients. We present a retrospective analysis of 50 patients with blunt chest trauma who were treated in the Respiratory Unit of Groote Schuur Hospital, Cape Town, during 1980. Conservative management was not possible in 21 patients because of severe associated injuries. The remaining 29 patients were treated either with continuous positive pressure ventilation (CPPV) or continuous positive airway pressure (CPAP) by face-mask and thoracic extradural analgesia. The conservatively treated patients spent less time in the Intensive Care Unit and had fewer complications. Thoracic extradural analgesia provides optimal pain relief with resultant increase in vital capacity and an improvement in arterial blood gas levels. Current management of blunt chest trauma is directed at early withdrawal of continuous ventilatory support as soon as this can be replaced either with thoracic extradural analgesia and CPAP by mask, or with CPAP by mask alone.

Adult↗
PubMedDate not supplied

Ticlopidine-induced thrombotic thrombocytopenic purpura.

Thrombotic thrombocytopenic purpura (TTP) occurs in association with a wide variety of disorders including infections, connective tissue diseases, and solid organ tumors. It also may coincide with administration of drugs such as mitomycin, metronidazole, oral contraceptives, cyclosporine, and many others. We report the occurrence of TTP in a patient shortly after the initiation of ticlopidine.

Adult↗