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Biomedical subjects

D P Maguire

Publications and source records attributed to D P Maguire.

10 recordsLinked to original sources
PubMed2001

Evaluation of transesophageal atrial pacing in the prone and lateral positions.

OBJECTIVE: To develop recommendations for positioning the second-generation pacing esophageal stethoscope for transesophageal atrial pacing in patients positioned prone (P), right lateral decubitus (RLD), and left lateral decubitus (LLD). DESIGN: Prospective; patients assigned consecutively. SETTING: Tertiary and university hospitals. PARTICIPANTS: Thirty (10 in each position group) adult patients undergoing surgery. INTERVENTIONS: The optimal depths of insertions (DOI) where pacing current threshold was minimal (THmin) were determined first when supine, then after positioning. MEASUREMENTS AND MAIN RESULTS: Transesophageal atrial pacing was successful in all patients supine and after positioning. The optimal DOI varied from 2 cm less deep to 4 cm deeper in positioned patients compared with supine patients. Patients positioned P required equal or up to 8 mA greater current outputs to achieve transesophageal atrial pacing; LLD and RLD patients may require up to 8 mA greater or lesser current compared with supine patients. CONCLUSION: Transesophageal atrial pacing can be used safely and effectively in patients positioned P, RLD, and LLD. Recommendations are presented for positioning the pacing esophageal stethoscope. Emphasis is given to using the lowest DOIs and smallest currents to reduce the chance of transesophageal ventricular pacing.

Adolescent↗
PubMed1999

Skin protection and breakdown in the ELBW infant. A national survey.

The purpose of this study was to learn how neonatal intensive care unit (NICU) nurses describe the problem of skin breakdown in the extremely low birth weight (ELBW) infant, examine interventions currently used to prevent and treat ELBW infant skin breakdown, and to learn how nurses describe and measure skin breakdown. Questionnaires were sent to 482 NICUs in the United States, and a response was requested from a registered nurse with at least 2 years NICU experience currently employed in the NICU who regularly managed ELBW infants. Questionnaires were returned from 215 NICUs (45%). Analysis revealed that an average of 21% of ELBW infants suffered skin breakdown during the 1st week of life. Nurses who reported the least problems with ELBW infant skin breakdown followed skin-care protocols that limited use of tape and made liberal use of Aquaphor to protect fragile skin. Recommendations from this study include the development of an objective tool to rate skin breakdown and further study of product efficacy used in the treatment of skin breakdown.

Data Collection↗
PubMed1998

Effect of heparin-bonded pulmonary artery catheters on the activated coagulation time.

OBJECTIVE: This study evaluated the effect of a heparin-bonded pulmonary artery catheter (PAC) on the activated coagulation time (ACT). DESIGN: A prospective, controlled comparison. SETTING: A tertiary care university hospital. PARTICIPANTS: Adult cardiac surgery patients. INTERVENTIONS: Celite ACTs were measured from arterial and central venous blood samples before and after the insertion of a heparin-bonded PAC. Thromboelastograms were also obtained from central venous blood samples before and 2 minutes after PAC insertion. MEASUREMENTS AND MAIN RESULTS: There was no significant difference between the sample sites before PAC insertion. After PAC insertion, the central venous ACTs were significantly increased compared with the corresponding arterial measurements at 2, 5, 10, and 20 minutes (p < 0.005, analysis of variance [ANOVA] for repeated measures, Fisher's protected least significant difference [PLSD]). The 2-minute post-PAC reaction time from the central venous blood sample was greater than 60 minutes in all cases. CONCLUSION: The heparin-bonded PAC was associated with a localized, time-dependent alteration in the ACT. Whenever possible, blood samples for baseline ACT measurements should be obtained from an arterial catheter to minimize the anticoagulant effects from the PAC.

Adult↗
PubMed1998

An alternate method for calibrating the thromboelastograph.

OBJECTIVE: This study evaluated various substances that could be used to calibrate the Thrombelastograph. DESIGN: Prospective, controlled comparison. SETTING: Operating room laboratory at a tertiary care university hospital. PARTICIPANTS: None. INTERVENTIONS: Six substances commonly available in the operating room setting (ointments, creams, and gels) were analyzed by thromboelastography for 3 minutes. Sixty measurements were made for each substance. MEASUREMENTS AND MAIN RESULTS: Thromboelastographic analysis of the ointments and cream preparations had an amplitude variability that exceeded 10 mm within the 3-minute recording period. The conductive gel had the most reproducible thromboelastography tracing with a mean amplitude of 62.5 +/- 1.1 mm (analysis of variance, p < 0.0005). There was a significant correlation between the reported viscosity of the three gels and the deflection amplitude (linear regression, R2 = 0.97; p < 0.0001). CONCLUSION: Conductive gel is a useful substance for quickly checking the functional status of the Thrombelastograph at an operational stage. Calibration of the Thrombelastograph using a gel of known viscosity is clinically relevant and may be more practical than testing with thromboelastographic-defined normal and abnormal blood analogs.

Calibration↗
PubMedDate not supplied

Pain perception in the neonate: implications for circumcision.

Routine neonatal circumcision is still performed in most centers without the benefit of anesthesia. The authors give a review of the anatomy and physiology of the pain response as it relates to newborns, and discuss the growing body of literature regarding the ability of these very young patients to perceive pain. The discussion focuses on the relevance of this information to the controversial issue of the use of anesthesia during circumcision.

Circumcision, Male↗