Search PubMed⌕ Search

Biomedical subjects

I D Conacher

Publications and source records attributed to I D Conacher.

At least 19 recordsLinked to original sources
PubMed2004

Anaesthesia for laparoscopic urological surgery.

Laparoscopy for urological surgery is a relatively recent surgical innovation. Some centres have substantial experience of single operations, but very few have experience with a comprehensive range. Our programme began with nephrectomy and pyeloplasty, and has expanded to provide for a living related kidney donor programme and for other procedures usually conducted open. Recently, it has included prostate and bladder cancer surgery. The learning curve and implications for anaesthesia are described on the basis of the experience of one anaesthetist with 124 patients. Perioperative care issues, in common with other abdominal laparoscopic procedures, relate to operating positions, the consequences of carbon dioxide under pressure in the abdomen and postoperative analgesia. There is only a small requirement for regional anaesthesia supplementation and invasive analgesia. The corporate laparoscopic cholecystectomy experience was used as the foundation for anaesthesia and to delineate specific organ system issues and any interventions. Significant differences were found in the spectrum of the urological patient population and comorbidity, notably renal function or dysfunction, and complications.

Anesthesia, General↗
PubMed2004

Local anaesthesia and sedation for rigid bronchoscopy for emergency relief of central airway obstruction.

We report three experiences that illustrate the use of local anaesthesia for rigid bronchoscopy. All patients were acute emergencies, with life-threatening central airway problems. Instruments were inserted after the airway was anaesthetised using a technique that owes much to mid 20th Century methods for inserting endobronchial blockers. There is discussion about requirement to preserve and conserve self-ventilation and the securing of compromised central airways without the aid of neuromuscular blocking agents. Historical aspects of bronchoscopy are reviewed. Concomitant sedation reduced the unpleasantness of the experience in a way that in the past could only be dealt with by careful attention to the humanitarian elements of detail. Problems of oxygenation were ameliorated by periodically superimposing intermittent jetting with a Sanders injector fed from the oxygen pipeline. A need for developing and refining topical and other local anaesthetic techniques for rigid bronchoscopy is anticipated with the expansion of services for tracheo-bronchial stenting and lasering.

Aged↗
PubMed2003

Anaesthesia and tracheobronchial stenting for central airway obstruction in adults.

In the last decade, stents suitable for the management of tracheobronchial stenoses and obstruction have evolved from bulky prostheses requiring tracheal resection to small devices that are self-expanding and can be inserted using fibreoptic techniques. The experience base for this review is more than 100 patients between 1989 and 2001 who have been anaesthetized for stent insertion. Early cases required rigid bronchoscopy for the routine of insertion. Anaesthetic techniques have evolved from those that were designed and developed for laser surgery in the central airways. The advent of modern devices now extends the variety of anaesthetic management techniques that can be used. But the original one, based on the requirement for use of a rigid bronchoscope, is best for dealing with complications and extracting problem stents. The most frequent complication of the processes of stent insertion has been respiratory failure because of carbon dioxide retention, consequent on obstruction with secretions in the area of the carina. The nature of central airway problems suggests that anaesthesia induction, management and teaching should not be founded on the conventional model-base of upper airway obstruction.

Adult↗
PubMed2003

Pain disaggregation theory--statistical nonsense or a pointer to a paradigm for quantum nociception?

BACKGROUND: The various patterns of patients' experience of treated acute post-thoracotomy pain exemplify the phenomenon of disaggregation. The intent in this study was to define a theory of disaggregation with a hard-wired neuroanatomical model of thoracotomy pain. METHODS: In order to distinguish the disaggregated nociception conducted along one of three possible pathways, the vagus, the phrenic and, in this study, the intercostal nerves, data from 143 patients undergoing thoracic surgery, and that from two previously conducted studies of multimodal analgesic regimens, were reviewed. The values of one subjective outcome measure (verbal rating score) at different stress levels-at rest, on raising the arm, and on coughing (dynamic pain scores)-were used to construct individuals' charts (pain profiles) of the progress of pain relief over time. These were batched, and analysed using statistics of summary measures. RESULTS: This was a crude exercise in the handling of redundant data, but there is a suggestion that it is possible to distinguish a disaggregated route by an effect of a treatment on a mass of nociception. CONCLUSIONS: This information could underpin a paradigm of quantum nociception, and has potential to quantify aspects of analgesia practice and current and future neurophysiological theories of pain. Prospective studies are warranted.

Analgesia↗
PubMed2001

Post-thoracotomy analgesia.

Pain relief has come a long way in 20 years. Many aspects of the relief of pain of thoracic surgery must be rationalized and modernized to meet the demands placed on services and subject to new dynamics. To place the present state of practice and knowledge in the context of an anticipation that such attitudes will impact on and, ultimately, drive services for relief of pain, the key issues of safety, defining and measuring quality, and giving value for money must be addressed. Rationing is the impetus; the exercise to be conducted by those interested in the field of thoracic pain relief is to recognize that not all patients can have or require five-star services and gold standard techniques but are entitled to an equally high quality and measure of pain relief. Newer drugs, such as clonidine, ropivacaine, and modified local anesthetics, are on the horizon; old drugs, such as ketamine, are being revisited. Their place in the field will become apparent only if the ways that outcome measures are presented are more uniform and standard. Disaggregation analysis, pain profiling, a revisitiation of respiratory restoration factor, and optimization modeling are suggested ways forward to meet the clinical and organizationally holistic population forces being generated on the cusp of the third millennium. Increasingly, we live in a world defined by guidelines and protocols. The challenge is ensuring that these measure up to the watchwords--effective, safe, affordable.

Analgesia↗
PubMed2001

Total spinal anaesthesia in association with insertion of a paravertebral catheter.

An association between intercostal nerve block and the development of a total spinal is rare. Usually, subarachnoid injection is considered to have followed intraneural placement or inadvertent entrance into a dural cuff extending beyond an intervertebral foramen. We report a patient that followed injection of local anaesthetic into a paravertebral catheter sited at surgery in the thoracic paravertebral space of a patient undergoing thoracotomy. This was a life-threatening event that occurred on two occasions before the definitive diagnosis was made. It is considered likely that the paravertebral catheter entered an intervertebral foramen and the tip perforated the dura.

Anesthesia, Spinal↗
PubMed2000

Implications of a tracheal bronchus for adult anaesthetic practice.

The problems posed by tracheal intubation in the presence of a tracheal bronchus in adults are exemplified with three case histories. The anomaly has been categorized into three types on the basis of its potential to cause problems when attempting intubation. Suggestions are given for ways of securing the airway that are safe and less likely to result in obstruction and hypoxia.

Adult↗
PubMed2000

Management of complications of tracheal surgery--a case of dehiscence.

We report a case of tracheal stenosis in a patient with immune thrombocytopenia who presented 4 yr after splenectomy. The 20-yr progression of the stenosis and management, including resection, is charted. The period after resection was complicated by wound infection, surgical emphysema, mediastinitis and dehiscence of the anastomosis of the trachea. The management of patients with tracheal lesions is discussed, but concentrates on airway care after tracheal resection when complications developed. A laryngeal mask airway was used to stabilize an uncuffed tracheal tube at the site of dehiscence.

Adult↗
PubMed1998

Anesthetic management of laser surgery for central airway obstruction: a 12-year case series.

The retrospective 12-year experience of anesthetizing patients with central airway obstructions for laser treatment with a CO2 and two types of Nd:YAG laser has been reviewed and evaluated. More than 300 patients have been treated, many on several occasions. The beneficial effects of treatment to the majority of patients have been significant. There has been a small associated mortality because the majority are in the high-risk categories of fitness for anesthesia, but no clinical evidence that it is directly attributable to the techniques of anesthesia or ventilation. Therefore, although laser technology has evolved into systems suitable to be applied with fiberoptic bronchoscopes and local and sedation anesthesia, the use of a rigid bronchoscope and the evolved techniques of anesthesia and ventilation remain appropriate to the clinical needs and offer advantages.

Airway Obstruction↗
PubMed1998

Why the Y?

Explore the source record for details and available documents.

Anesthesia↗
PubMed1998

Transoesophageal echocardiography in the management of whole lung lavage.

The effects of two lung ventilation, one lung ventilation and alveolar lavage on right ventricular mechanics in a patient have been observed using transoesophageal echocardiography (TOE). Alveolar lavage resulted in additional stresses to those of one lung ventilation (OLV) and the point when these were noted to be resulting in right ventricular changes was used as the signal to terminate the filling phase of a cycle of alveolar lavage. A significant increase in right ventricle afterload occurred on starting OLV. The response to lung lavage was biphasic, initially a further increase in afterload followed by a reduction in preload. Because there was rapid adaptation to these changes, it was felt appropriate to perform sequential lung lavage during the same anaesthetic. In similar circumstances where pulmonary vascular resistance is changed, information obtained from TOE may be used to guide therapy.

Adult↗