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Biomedical subjects

H M Munro

Publications and source records attributed to H M Munro.

At least 37 records · Page 2Linked to original sources
PubMed1994

Comparison of the analgesic and emetic properties of ketorolac and morphine for paediatric outpatient strabismus surgery.

In a prospective, double-blind, randomized study, we have compared i.v. ketorolac and morphine in paediatric outpatients undergoing strabismus surgery. Forty-two ASA I or II children, aged 2-12 yr, were allocated randomly to receive either ketorolac 0.75 mg kg-1 i.v. or morphine 0.1 mg kg-1 i.v. and metoclopramide 0.15 mg kg-1. Anaesthesia was induced with propofol and maintained with propofol and nitrous oxide. Pain was assessed at 15-min intervals until discharge, and the incidence of nausea and vomiting was recorded for the first 24 h. There was no difference in pain behaviour scores or recovery times. The incidence of nausea and vomiting during the first 24 h was 19% in the ketorolac group and 71% in the morphine group (P < 0.001). We concluded that ketorolac was an effective analgesic for this type of surgery and that it was associated with less postoperative emesis than morphine and metoclopramide.

Ambulatory Surgical Procedures↗
PubMed1994

Continuous invasive cardiac output monitoring--the Baxter/Edwards Critical-Care Swan Ganz IntelliCath and Viligance system.

We evaluated the Baxter/Edwards Critical-Care Swan Ganz IntelliCath continuous cardiac output catheter and Vigilance continuous cardiac output monitor in critically ill adult intensive care patients, and compared cardiac output measurements obtained from this new system with those from a standard bolus thermodilution technique using cold normal saline. Nine Swan Ganz IntelliCath catheters were inserted into patients selected at random, following the decision that pulmonary artery catheter monitoring was required. A total of 100 comparisons were made in nine patients. We found the Swan Ganz IntelliCath catheter to be both easy to insert and position, and simple to use. There were no complications or technical difficulties. The mean cardiac output measured by the continuous system was 8.00 l/min (SD 1.66/min) compared to 8.02 1/min (SD 1.74 l/min) using bolus techniques. Continuous cardiac output values correlated well with bolus measurements (r = 0.87), there was excellent accuracy (bias of 0.02 l/min) and precision was acceptable (limits of agreement of -1.71 to 1.75 l/min). These larger than anticipated limits of agreement may not reflect any inaccuracy in the continuous measurement system, rather they may highlight the extent of well recognised potential errors inherent in the intermittent bolus technique. The availability of a system to measure cardiac output continuously provides a major improvement in intensive care monitoring. This system will permit the rapid and accurate assessment of the response of patients to therapy while providing increased diagnostic facilities and a new research tool.

Adult↗
PubMed1993

The cardiovascular response to ketamine: the effects of clonidine and lignocaine.

The effectiveness of clonidine or lignocaine in reducing the cardiostimulatory effects of ketamine was studied. A double-blind, randomized design was used in three groups of 20 patients each, of ASA grade 1 or 2 presenting for minor elective surgery. The clonidine group received 0.3 mg clonidine orally with the premedication while the lignocaine group received 1.5 mg.kg-1 lignocaine prior to induction. The third group formed the controls. All patients were induced with 2 mg.kg-1 ketamine intravenously. The systolic blood pressure in the clonidine group was significantly lower than that of both the control and lignocaine groups throughout the study (P < 0.05). It was concluded that clonidine was effective in reducing the hypertensive response to ketamine, whereas lignocaine had no effect.

Adult↗
PubMed1993

Propofol infusion and the incidence of emesis in pediatric outpatient strabismus surgery.

A prospective, randomized, double-blind study was conducted to examine the effect of a propofol infusion on the incidence of postoperative emesis in children undergoing outpatient strabismus surgery. Seventy-eight children, aged 3-12 yr, were allocated randomly to receive either nitrous oxide and halothane or nitrous oxide and a propofol infusion for the maintenance of anesthesia. The overall incidence of vomiting during the first 24 h was 64% in those receiving halothane and 41% in those receiving the propofol infusion; this difference was statistically significant (P < 0.05). In children who received no opioids postoperatively, the incidence of vomiting in the first 24 h was 71% in the halothane group and 24% in the propofol group; this difference was also significant (P = 0.001). We conclude that propofol was effective in reducing the incidence of postoperative emesis in pediatric outpatient strabismus surgery.

Anesthesia↗
PubMed1991

Intraosseous infusion for resuscitation.

An 11 week old infant who had a cardiac arrest secondary to gastrointestinal haemorrhage and was successfully treated using intraosseous infusion is reported. The child was discharged with no apparent neurological deficit.

Bone Marrow↗
PubMed1989

Upper airways obstruction presenting as asthma--three case histories.

Distinguishing an acute asthmatic attack from upper airways obstruction can prove difficult. Three cases of upper airways obstruction presenting as asthma and requiring ventilatory support are reported. Problems relating to correct diagnosis and subsequent management are discussed. Two of the cases were a result of thyroid gland pathology, and the other was due to acute laryngotracheobronchitis.

Adult↗
PubMed1985

Infectivity of a strain of Cryptosporidium found in the guinea-pig (Cavia porcellus) for guinea-pigs, mice and lambs.

Cryptosporidiosis was diagnosed in guinea-pigs bred by a commercial laboratory supplier on histological examination of the intestine. Oral transmission to laboratory guinea-pigs aged up to 16 weeks and to infant mice, with gut contents containing oocysts, was successful, but the organism failed to infect adult mice. From day 5 post-inoculation (pi) in guinea-pigs, infection of the ileum was associated with villous stunting and fusion, and with infiltrates of macrophages and other mononuclear cells, and eosinophils. Some guinea-pigs died; others were depressed and anorectic, with diarrhoea or watery caecal contents. Mouse infections were subclinical and caused no significant pathological changes. By contrast, a bovine Cryptosporidium isolate infected infant mice but failed to infect young guinea-pigs. Guinea-pigs and infant mice excreted oocysts in faeces after a prepatent period of 3 to 4 days. Some guinea-pigs excreted oocysts for up to 2 weeks, but excretion in mice lasted only about 4 days. Infection of guinea-pigs by contact with a contaminated environment occurred, with excretion of oocysts between 17 and 27 days after exposure. An indirect fluorescent antibody test (IFA) showed that antibody was present by day 17 pi with infected bowel contents, but none was detected in the guinea-pigs exposed to the contaminated environment. The IFA test demonstrated a serological relationship between the guinea-pig isolate and a bovine strain used to infect gnotobiotic lambs. Transmission electron microscopy of intestine from infected guinea-pigs and mice showed that more than one schizont generation occurred. The first consisted of 8 merozoite packets attached to enterocytes, but many packets of 2 or 4 merozoites of the second or subsequent generations were apparently released into the gut lumen. Fixed microgametocytes contained lipid vacuoles and had microneme-like structures in their cytoplasm. Oocysts and sporocysts were also identified, with sporulation occurring within the parasitiphorous vacuole. A sparse infection was established in 1 of 2 12-day-old specific pathogen-free lambs by day 3 pi, but no oocysts were detected in its caecal contents or those of a second lamb killed 4 days later.

Animals↗
PubMed1980

Psoroptic mange in goats in Fiji.

Mange caused by Psoroptes cuniculi was first recognised in goats in Fiji in 1977. Of 33 widely separated herds examined 16 were infested 4 herds having the "extensive" type lesions in older goats. Treatment of the skin and superficial ear lesions with malathion or gamma-BHC was successful but mites survived in the proximal parts of the ear canal. Re-appearance of the mites following treatment was a common problem.

Animals↗
PubMed1978

Nutritional consequences of excess amino acid intake.

Various mechanisms respond to intakes of amino acids in excess of those required for normal tissue function. When excessive amounts of amino acids are taken, catabolism by enzymes in the liver and elsewhere is accelerated when intake exceeds requirements. In addition, changes in the free amino acid levels in the brain signal the nervous system centers regulating food consumption, and eating patterns are affected. This central nervous system mechanism may even determine the proportions of protein and of energy--yielding nutrients chosen in the diet through a mechanism regulated by the entry of tryptophan and other neurotransmitter precursors into the brain. These observations on protective mechanisms are considered in relation to effects obtained by feeding disproportionate amounts of amino acids. Intakes of large amounts of amino acids can produce toxicities, in which plasma concentrations of the administered amino acid rise to very high levels. Antagonisms arise from feeding excess of one amino acid that can be relieved by feeding a structurally related amino acid. Finally, amino acid imbalances are produced by adding surpluses of essential amino acids other than the essential amino acid most limiting for growth; the growth depression caused by this addition can be relieved by adding more of the most limiting amino acid to the diet. In all circumstances involving feeding with disproportionate amounts of amino acids, there is evidence of changes in brain amino acid levels. It is suggested that these changes play an important role in initiating protective responses against abnormal amino acid intakes.

Amino Acids↗
PubMed1977

Autoimmune (idiopathic) thrombocytopenic purpura in pregnancy and the newborn.

The effects of autoimmune (or idiopathic) thrombocytopenic purpura (ATP) on 51 pregnancies in 29 women is presented. There is no convincing evidence that the clinical course of ATP is influenced by pregnancy. There was no increased incidence of obstetric complications. No problems were encountered following spontaneous vaginal delivery or low forceps delivery. There were no perinatal deaths. Twenty newborn infants were studied in detail and significant thrombocytopenia was present in half of them. The severity of thrombocytopenia in the newborn correlated closely with the severity of maternal disease; those women in clinical remission following splenectomy but with presumed high levels of antiplatelet antibodies were those most likely to be delivered of affected newborn infants. The cord blood platelet count was the most reliable guide to the potential severity of the neonatal thrombocytopenia. Platelet counts were lowest between the second and fourth days of neonatal life. The management of the severely affected infant is discussed.

Blood Cell Count↗