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Biomedical subjects

F Reynolds

Publications and source records attributed to F Reynolds.

At least 109 records · Page 6Linked to original sources
PubMed1991

Extending epidural blockade for emergency caesarean section. Evaluation of 2% lignocaine with adrenaline.

Pre-existing epidural analgesia was rapidly extended in 36 consecutive patients presenting for emergency caesarean section by using 20 ml of 2% lignocaine + 1/200,000 adrenaline freshly prepared given by slow bolus injection. Despite a wide range of initial analgesic sensory levels the technique produced blocks that were dense with adequate anaesthesia for surgery in all patients within 12.5 min. The plasma local anaesthetic concentrations were well below the toxic range. Neonatal condition was good.

Journal Article↗
PubMed1991

A comparison of epidural diamorphine with intramuscular papaveretum following caesarean section.

Following caesarean section carried out under epidural blockade using local anaesthetic only, 40 consenting women were randomly allocated to receive either epidural diamorphine 2.5-5 mg in 10 ml physiological saline and intramuscular saline or epidural saline and intramuscular papaveretum 10-20 mg, dosage depending on weight, when the pain returned. When analgesia was next requested the alternative treatment was given. A visual analogue pain score was recorded before and 15, 30, 60, 120, 180 and 240 min after the first treatment. Respirations were counted and symptoms noted. On the following day the mother was asked whether she preferred the first or the second treatment. Both treatments produced a reduction in pain score but analgesia was significantly better with epidural diamorphine and the duration of action (8.5 +/- 5.2 h) was significantly longer than that following intramuscular papaveretum (4.1 +/- 2.3 h, P < 0.01). Two mothers who received epidural diamorphine initially required no further analgesia. No difference in respiratory rate was noted but side-effects were more frequent with epidural diamorphine. Despite this more women preferred this treatment. Because of enhanced mobility provided by good analgesia epidural diamorphine is worth offering to women following caesarean section.

Journal Article↗
PubMed1991

Lumbar epidural diamorphine following thoracic surgery. A comparison of infusion and bolus administration.

Twenty-two patients received a single dose of diamorphine 5 mg through a lumbar epidural catheter before thoracic surgery. The patients were transferred after surgery to a high dependency unit where they were allocated randomly to receive either an infusion of epidural diamorphine at a rate of 1 mg/hour (group 1) or bolus doses of epidural diamorphine 5 mg on demand (group 2). There was no statistically significant difference between the groups in visual analogue pain scores in the first 18 postoperative hours. Arterial carbon dioxide tension was elevated in both groups and was consistently higher in group 1 than in group 2, with a statistically significant intergroup difference 12 hours after operation. Respiratory rate was not a useful index of respiratory depression. The commonest nonrespiratory side effect was urinary retention, but the incidences of this and other minor side effects were similar in the two groups.

Adult↗
PubMed1991

Ropivacaine.

Explore the source record for details and available documents.

Amides↗
PubMed1991

A comparison of serum and saliva paracetamol concentrations.

The relationship between serum and saliva paracetamol concentrations was investigated in twenty healthy volunteers. The plasma and saliva drug concentrations showed a significant correlation (r = 0.67). However the agreement between the two methods of measurement was poor with limits of agreement of -15.3 mg l-1 to +15.9 mg l-1 with mean sample values of 19.2 and 19.5 mg l-1 for plasma and saliva, respectively.

Acetaminophen↗
PubMed1990

The subdural space: the third place to go astray.

Subdural placement of the tip of the Tuohy needle or epidural catheter may account for many unexpected complications of attempted epidural blockade, for example, 'unexplained' headache, false-negative aspiration test down needle or catheter, false-negative test dose, unilateral block, delayed total spinal and neurological sequelae, as well as profound block of delayed onset that is characteristic of subdural blockade. Cases are reported in support of this hypothesis.

Adult↗
PubMed1990

Peri-operative care in restrictive respiratory disease.

A total of 139 of 473 severely disabled, mainly ventilator-dependent patients required some form of surgery. Such patients require surgery more frequently than normal individuals, both because of their disability and because even minor unrelated disorders superimposed on permanent disability cause greater handicap. We report the peri-operative management and postoperative complications of 142 operations on 83 patients between 1982 and 1987. A simple inhalational anaesthetic technique was used; opioids and muscle relaxants were seldom given. Negative pressure ventilation was employed in the postoperative period when appropriate, and was combined with vigorous chest physiotherapy. There were three peri-operative deaths, but the overall death rate in the patients who underwent surgery was no greater throughout the study period than in those who did not require surgery. We believe that an aggressive surgical approach is appropriate in severely disabled, ventilator-dependent patients.

Adult↗
PubMed1990

Effect of umbilical perfusate pH and controlled maternal hypotension on placental drug transfer in the rabbit.

The purpose of this study was to explore the effect that fetal acidosis and poor maternal placental blood flow may have on the rate of passage across the placenta of drugs commonly used in labor: bupivacaine and meperidine. The rabbit placenta perfused in situ on the fetal side was used, and antipyrine (phenazone) was included as an index of placental exchange and of maternal placental flow. Bupivacaine and meperidine (both 1.25 mg/mL) and antipyrine (4 mg/mL) were infused into a maternal external jugular vein, at 3 mL/h, after loading, in seven anesthetized does. A single placenta in each doe was perfused via the umbilical arteries with Krebs' bicarbonate buffer at pH 7.5 (phase 1), 7.0 (phase 2), and 7.5 (phases 3-5). During phase 4 maternal blood was withdrawn so as to reduce maternal arterial pressure by 35%, and in phase 5 it was reinfused. Concentrations of drugs were measured during each of the five phases in maternal arterial plasma (Cma) and in the effluent perfusate collected from the umbilical vein (Cuv). From these data, placental clearance rates (Cuv x umbilical flow/Cma) were calculated for each drug at each phase. Clearance of bupivacaine and meperidine increased (P less than 0.03) during phase 2, whereas that of antipyrine did not. Clearance of meperidine and antipyrine, but not of bupivacaine, decreased during phase 4. If these results can be extrapolated to the clinical situation, they suggest that the adverse effects of drugs may well be exacerbated in the presence of fetal compromise.

Anesthesia, Obstetrical↗
PubMed1989

Intradermal hepatitis B immunization with yeast-derived vaccine: serological response by sex and age.

The efficacy and acceptability of yeast-derived recombinant hepatitis B vaccine given by the intradermal route was investigated in 221 health care volunteers. Two hundred and sixteen received a full course of three doses of vaccine. Only one subject was withdrawn because of a significant adverse reaction (psoriasis). The vaccine stimulated an antibody response in 81%. The response to the vaccine was better in women than in men (87% compared with 71%, p = 0.007) and in women below the age of 40 years compared with older women (94% compared with 76%, p = 0.01). For men the response showed a sequential decline with age for each decade (90% responders from age 29 or less, 72% aged 30-39 and 65% aged 40 or more, p = 0.04). Retrospective enquiry showed that over 90% had found the intradermal route acceptable and 59% would prefer vaccine by the intradermal route in preference to intramuscular notwithstanding local reactions. Although the seroconversion rate was of a high order in younger women the antibody titres were not high with only 9 of 215 recipients developing titres greater than 1000 mIU/ml, a level which could be expected to ensure prolonged immunity. A fourth intradermal dose of vaccine given to 60 volunteers who had shown a low response (less than 38 mIU/ml) or no serological response to a three-dose course stimulated a good booster effect (to 150-600 mIU/ml) in only 5 (8%).

Adult↗
PubMed1989

Effect of time and adrenaline on the feto-maternal distribution of bupivacaine.

Following lumbar extradural analgesia with 0.5% bupivacaine, the placental transfer of bupivacaine was examined in 40 women undergoing elective and 40 women undergoing emergency Caesarean section. Within each group, the patients received randomly either plain bupivacaine or bupivacaine with adrenaline 1 in 200,000. Plasma bupivacaine concentrations were measured in blood samples taken simultaneously at delivery from the umbilical vein (UV), umbilical artery (UA) and maternal vein (MV). Bupivacaine concentrations in MV, UV and UA were not significantly affected by the presence of adrenaline, but were positively correlated with first dose to delivery interval (FDD) while MV and UV were inversely correlated with last dose to delivery interval (LDD). Mean ratio of UV:MV concentrations of bupivacaine was 0.346 and for UA:MV it was 0.305. There was no significant correlation between any fetal:maternal ratio and FDD or LDD. UA:UV ratio appeared to increase towards unity 30-40 min after the last dose. The presence of adrenaline was associated with an increase in UA:UV in the elective group (P less than 0.01). In eight patients who received adrenaline there was reverse placental transfer (UA:UV greater than 1). There was no evidence of progressive fetal accumulation of bupivacaine beyond 30-40 min.

Anesthesia, Epidural↗
PubMed1989

Effect of adrenaline on placental transfer of bupivacaine in the perfused in situ rabbit placenta.

Following general anaesthesia, each of 18 pregnant rabbits received an i.v. infusion, at a declining rate, of 0.125% bupivacaine, either plain solution followed by adrenaline (1.25 micrograms ml-1)-containing solution (n = 10) or vice versa (n = 8). All solutions contained antipyrine as an index of placental exchange. In each rabbit, a single fetal sac was opened, the umbilical vessels were cannulated and the placenta was perfused in situ with buffered Krebs solution containing Dextran. Bupivacaine and antipyrine concentrations were measured in effluent perfusate (fetal) and in maternal plasma sampled simultaneously. Mean maternal arterial pressure and mean placental perfusion pressure were not altered by adrenaline. Fetal:maternal concentration (F:M) ratios of antipyrine decreased significantly (P less than 0.05) during the second half of the experiment. In contrast, F:M ratios of bupivacaine were unchanged during the time course of the experiment and unaltered by the addition of adrenaline. It is concluded that neither adrenaline nor minor alterations in maternal placental flow affect placental transfer of bupivacaine.

Animals↗
PubMed1989

Effect of adrenaline on the distribution of bupivacaine in the rabbit fetus.

Adrenaline may decrease uterine blood flow and influence transplacental distribution of bupivacaine. Sixteen pregnant rabbits received an i.v. infusion of 0.125% bupivacaine either plain (n = 8) or with adrenaline 1.25 microgram ml-1. At 15-min intervals following the start of the infusion, rabbit fetuses were removed serially and bupivacaine concentrations measured in maternal arterial plasma, fetal plasma and brain, amniotic fluid and placenta. The presence of adrenaline was associated with increased bupivacaine concentration in placenta; there was no other significant effect on fetal bupivacaine concentrations or ratios. Fetal:maternal plasma ratios increased (P less than 0.05), while fetal brain:fetal plasma ratios decreased (P less than 0.05) significantly with time.

Amniotic Fluid↗