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Biomedical subjects

F Reynolds

Publications and source records attributed to F Reynolds.

At least 127 records · Page 7Linked to original sources
PubMed1989

Epidural fentanyl and perineal pain in labour.

Perineal pain during the course of routine epidural analgesia with bupivacaine was treated with a 10-ml top-up of either bupivacaine 25 mg, fentanyl 100 micrograms or fentanyl 100 micrograms plus bupivacaine 10 mg, in 46 women in the first stage of labour. Only fentanyl plus bupivacaine produced consistently reliable analgesia which was quicker in onset and longer in duration (140, SD 26 minutes) than either fentanyl (114, SD 26 minutes) or bupivacaine (99, SD 44 minutes) alone. Side effects, itching and drowsiness, which were not troublesome, were more frequent in the groups given fentanyl.

Analgesia, Epidural↗
PubMed1989

Pharmacokinetics in pregnancy and placental drug transfer.

Total body water increases in pregnancy and while the uterus, placenta, fetus, and amniotic fluid constitute part of this increase, the largest component is in the extracellular water. Fat stores also increase and thus the distribution volumes of all drugs expand, but the major effect is seen in polar drugs which are confined to the extracellular space. Cardiac output and renal function also increase and elimination of polar drugs is accelerated. In contrast, the elimination of lipophilic drugs may be retarded, and the effect on intermediate drugs is variable. Polar drugs cross the placenta slowly and accumulate in amniotic fluid and therefore in the fetal gut lumen. Lipophilic drugs cross the placenta rapidly and their transplacental distribution is dependent on relative maternal and fetal affinity: this is determined largely by protein binding on either side of the placenta. The fetus and neonate dispose of all drugs less rapidly than adults, the most efficient elimination processes being sulphate conjugation and renal excretion.

Adrenergic beta-Agonists↗
PubMed1988

Prediction of Wechsler Intelligence Scale for Children-Revised Full Scale IQ from the Quick Test of Intelligence and the Test of Nonverbal Intelligence for a referred sample of children and youth.

As part of comprehensive psychoeducational assessment procedures, the Quick Test of Intelligence, Test of Nonverbal Intelligence, and the Wechsler Intelligence Scale for Children-Revised were administered to 89 children and youth, who varied in age from 6-4 to 16-10. The sample consisted of 61 males and 28 females, of whom 37 were Black and 52 White. Regression equations were computed that used the WISC-R Full Scale IQ as criteria and the TONI and QT as predictors. The results clearly indicated that the TONI and QT are equally good predictors of the WISC-R FSIQ. Implications for the clinician are discussed.

Adolescent↗
PubMed1988

Effect of adrenaline on extradural anaesthesia and plasma bupivacaine concentrations during caesarean section.

The effect of adrenaline on the efficacy of extradural block and plasma bupivacaine concentrations was investigated in women undergoing elective (n = 40) and emergency (n = 40) Caesarean section. Patients were randomly allocated within these two groups to receive 0.5% bupivacaine 20 ml either plain or with adrenaline 1 in 200,000, as a single fractionated extradural injection. The elective plain group needed significantly more supplementary analgesia compared with the other three groups (P less than 0.05). In the elective group, plasma bupivacaine concentrations were significantly lower in the subgroup receiving extradural adrenaline than in the plain subgroup. This effect was not observed when comparing only those who received bupivacaine 100 mg. In the emergency group, there were no significant differences in plasma bupivacaine concentrations between the plain and adrenaline subgroups. Maximum plasma concentrations correlated significantly (P less than 0.0001) with dose of bupivacaine (mg kg-1). It is concluded that extradural adrenaline does not usefully reduce systemic absorption of 0.5% bupivacaine, but may improve its efficacy in extradural anaesthesia for elective Caesarean section.

Adult↗
PubMed1988

Preoperative intercostal nerve block: effect on the endocrine metabolic response to surgery.

The plasma cortisol and glucose responses to cholecystectomy were studied in 20 healthy patients. Ten patients received preoperative intercostal nerve blocks of the 6th to 12th nerves bilaterally using 0.5% bupivacaine with adrenaline 250 micrograms. The control group had the same quantity of adrenaline infiltrated into the intercostal space. Both groups had general anaesthesia with endotracheal intubation and controlled ventilation. In the non-blocked group, the mean cortisol concentration increased from a control value of 182.5 nmol litre-1 to a peak of 686.2 nmol litre-1 at 5.5 h after incision. In the blocked group the baseline serum cortisol concentration was 283.8 nmol litre-1 and it increased to a similar peak at 5.5 h. There were no significant differences between groups. The baseline plasma glucose concentration was also higher in the blocked group (4.45 mmol litre-1 compared with 3.94 mmol litre-1), but after a brief increase following the performance of the block decreased to only 14% above control values. The unblocked group exhibited substantial increase following the start of the surgery which continued for the duration of the study period to end at a mean of 6.48 mmol litre-1. These differences were significant (P less than 0.001). It is concluded that bilateral intercostal blocks may inhibit the glucose response to surgery, but have no effect on the cortisol response.

Anesthesia, General↗
PubMed1988

Maternal-fetal distribution of bupivacaine in the rabbit.

Bupivacaine was infused i.v. in nine anaesthetized pregnant rabbit does near term. Pups were removed at 10-15 min intervals and bupivacaine concentrations measured in fetal plasma, brain, placenta, amniotic fluid, maternal plasma sampled synchronously and maternal brain at the end of the experiment. Mean maximum fetal:maternal (F:M) ratio was 0.31 (SD 0.16) (range 0.18-0.64). Mean fetal brain:plasma ratios ranged from 2.04 to 5.09. There was no progressive increase in fetal brain bupivacaine concentration with time. Maternal brain:plasma ratio was 1.62 (0.81). However, maximum fetal brain concentration was only 0.27-0.86 of maternal. Concentrations increased with time in amniotic fluid, but did not exceed those in maternal plasma. Although there was some accumulation of bupivacaine in rabbit fetuses, tissue uptake could not account for low F:M ratios persisting beyond 80 min.

Amniotic Fluid↗
PubMed1988

H2 antagonists and bupivacaine clearance.

The effect of the H2 receptor antagonists cimetidine and ranitidine on bupivacaine clearance was assessed in women scheduled to undergo elective Caesarean section under epidural anaesthesia. Thirty-six women were randomly allocated to receive either no medication, cimetidine 400 mg or ranitidine 150 mg on the night prior to and on the morning of surgery. No significant difference was found between the peak bupivacaine levels: the mean (SD) values were 0.74 (0.17) microgram/ml, 0.81 (0.38) microgram/ml and 0.70 (0.24) microgram/ml in the control, cimetidine and ranitidine groups, respectively. Similarly, the H2 receptor antagonists did not alter the plasma bupivacaine against time curves, half-life or bupivacaine clearance in the three groups studied.

Adult↗
PubMed1987

Adverse effects of local anaesthetics.

Complications of local anaesthesia in general have been considered in so far as they may be confused with adverse effects of local anaesthetic drugs. Local anaesthetics may give rise to adverse reactions by a number of mechanisms. They affect nerve conduction and vasculature at the site of injection: a local effect; but is it unlikely that they ever produce an irreversible noxious effect on nerve fibres. They produce regional effects resulting from nerve conduction blockade; hypotension and respiratory depression by this mechanism are frequently mistaken for pharmacological effects of the agent concerned. They produce focal effects, usually when carried in high concentration via the arterial supply to the brain. They produce systemic effects following absorption or intravenous administration, which are manifested principally in the central nervous system. Ignorance or carelessness are frequently causative factors in serious reactions. Adequate oxygenation is vital in prophylaxis and immediate treatment of systemic toxicity, while resuscitative skill and equipment must always be to hand. Idiosyncrasy or allergy can only rarely be an excuse for adverse reactions to local anaesthesia.

Anesthesia, Conduction↗
PubMed1987

Comparison of trichloroethylene and enflurane as adjuncts to nitrous oxide and relaxant anaesthesia.

Forty women who underwent gynaecological surgery were randomly allocated to receive trichloroethylene, enflurane, or enflurane plus fentanyl as adjuncts to nitrous oxide/relaxant anaesthesia with controlled ventilation. No serious cardiac dysrhythmias were seen in any group. Each patient was observed postoperatively for 4 hours by a nurse blind to the technique used, and questioned at 24 hours by a similarly blinded anaesthetist. Recovery after trichloroethylene was not significantly prolonged although postoperative analgesia by visual analogue was better, opiate analgesia was required less frequently and there was less nausea and vomiting than in either of the enflurane groups. We argue for the continued use of trichloroethylene by this technique, because it costs one hundred times less than enflurane and because of the potential morbidity of the postoperative opiate dosage required after enflurane.

Adjuvants, Anesthesia↗