'Field' anaesthesia for an ICU procedure.
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Anesthesia, Inhalation↗
Biomedical subjects
J A Carter
Publications and source records attributed to J A Carter.
The ophthalmopathy of Graves' disease.
Ophthalmopathy is an integral component of Graves' disease. It usually appears at the same time as hyperthyroidism, and is characterized by proptosis (exophthalmos), periorbital and conjunctival edema, eye muscle dysfunction, and on occasion corneal ulceration or optic neuropathy. Graves' ophthalmopathy, like Graves' hyperthyroidism, is an autoimmune disease, but the mechanisms that initiate and maintain it are not known. Most patients can be treated conservatively, but a few require anti-inflammatory or surgical therapy to relieve symptoms and preserve vision.
Autoantibodies↗
Cardiovascular changes at antagonism of atracurium. Effects of different doses of premixed neostigmine and glycopyrronium in a ratio of 5:1.
The cardiovascular changes in the 10 minutes following antagonism of an atracurium-induced block were studied in 32 patients. A 5:1 ratio combination of either 15, 35, 55 or 75 micrograms/kg neostigmine, with a corresponding dose of 3, 7, 11, or 15 micrograms/kg of glycopyrronium was used for antagonism. The least change in heart rate was with neostigmine 15 micrograms/kg with an increase of more than 15 beats/minute found in only one patient. Antagonism with 35, 55 and 75 micrograms/kg neostigmine mixture produced the greatest increase in heart rate at one minute and this was significantly different from the effect of the 15 micrograms/kg dose. Twenty out of 24 patients given the larger doses had heart rate increases in excess of 15 beats/minute and in nine patients this ranged from 30 to 52 beats/minute, representing increases of 46-80% above baseline values. Arterial pressure increases after antagonism were statistically significant in all four groups, with no between-group difference; these were clinically unimportant. When antagonising an atracurium-induced block with clinically useful doses of neostigmine, the standard 5 : 1 ratio combination with glycopyrronium will result in an initial tachycardia.
Anesthesia, General↗
Resedation after bolus administration of midazolam to an infant and its reversal by flumazenil.
A 4-month-old infant was sedated with bolus doses of midazolam, and after initial apparent complete arousal, became unresponsive and hypotonic. Administration of flumazenil enabled differentiation of a residual drug effect from an intracerebral event.
Anesthesia↗
Antagonism of atracurium with neostigmine. Effect of dose on speed of recovery.
In 36 patients in whom anaesthesia was maintained with nitrous oxide and 0.5% isoflurane an atracurium-induced neuromuscular block was either allowed to recover spontaneously or antagonised with one of four doses of neostigmine (15 micrograms/kg, 35 micrograms/kg, 55 micrograms/kg or 75 micrograms/kg). The recovery times to a train-of-four ratio of 0.5, 0.75 and 0.9 were recorded. In patients given neostigmine, antagonism was at an average T1 of between 8.8% and 14.9%. There was no difference in the recovery times between the patients given neostigmine 35 micrograms/kg, 55 micrograms/kg or 75 micrograms/kg. Recovery after neostigmine 15 micrograms/kg was significantly slower than after the higher doses. One patient given neostigmine 75 micrograms/kg showed an unusual bimodal pattern of recovery. There appears to be no benefit in giving a larger dose than 35 micrograms/kg of neostogmine as a single bolus.
Adult↗
Contralateral tension pneumothorax during thoracotomy for lung resection.
A patient underwent right thoracotomy and upper lobectomy for a mass found on routine chest radiography. He became profoundly cyanosed with a bradycardia and severe reduction in oxygen saturation at completion of surgery. The diagnosis of tension pneumothorax on the contralateral side to surgery was made and treatment instituted. The causes, treatment and implications of such an event during general anaesthesia for lung resection are discussed.
Aged↗
Preactive planning and conceptions of success in elementary health education.
Prospective classroom teachers' thoughts and understanding about teaching health were examined in this study. The study described the preactive thought processes of classroom teachers as they planned a lesson on health and teachers' conceptions of success and failure during the lesson. Before teaching a 30-minute lesson in health, participants were asked to "think aloud" during a planning session. Content of the thoughts was audiotaped, transcribed, and analyzed. After the lesson, participants listed critical events they described as related to success and lack of success during the lesson. Content of the written accounts was organized into clusters with common elements. Findings indicated teachers' concerns during planning were related to identifying and arranging content for maximum involvement and enjoyment. Most teachers defined success in terms of student affective rather than cognitive behaviors.
Attitude↗
An evaluation of the incentive spirometer to improve lung function after cholecystectomy.
Forty patients who underwent elective cholecystectomy were allocated randomly to one of two groups. Patients in one group used an incentive spirometer as part of their postoperative chest physiotherapy; those in the other received routine postoperative physiotherapy as dictated by their needs. Each group contained equal numbers of smokers and nonsmokers, and the data from each group were analysed separately. The use of the incentive spirometer did not confer any benefits as judged by clinical evidence of pulmonary complications, pulmonary function tests or length of hospital stay.
Adult↗
Antihypertensive mechanism of ketanserin in postoperative hypertension after cardiopulmonary bypass.
The effect of ketanserin (0.15 mg/kg followed by an infusion at 6 mg/hr) was studied in 13 patients who developed hypertension (blood pressure greater than 150/90 mm Hg) after cardiopulmonary bypass (CPB) for coronary artery bypass grafting. Eleven patients responded to ketanserin with a decrease of arterial pressure from 159 +/- 15/83 +/- 10 mm Hg to 131 +/- 9/70 +/- 12 mm Hg (P less than 0.01), which was sustained during the subsequent infusion of ketanserin. Mean plasma ketanserin concentrations were maintained at 187 micrograms/L (range 118-525). No significant changes in plasma levels of 5-hydroxyindoles or in platelet 5-hydroxytryptamine content were observed during or after CPB, or after administration of ketanserin. Plasma epinephrine (398 +/- 124 pg/ml) and norepinephrine (1161 +/- 673 pg/ml) concentrations were markedly increased during the hypertensive period after CPB. Plasma epinephrine concentrations decreased (P less than 0.01) during ketanserin infusion to 213 +/- 101 pg/ml, whereas plasma norepinephrine concentrations did not change. The pressor response to three graded doses of phenylephrine was decreased during CPB (P less than 0.01), and a further decrease (P less than 0.05) occurred during infusion of ketanserin. The hypotensive effect of ketanserin after CPB may be attributable to alpha 1-adrenoceptor blockade rather than to its antiserotoninergic effect. Serotonin does not appear to be involved in the short-term disturbances of arterial pressure during or after CPB.
Aged↗
Some ventilatory effects of propofol as sole anaesthetic agent.
Ventilatory effects of propofol, used as a sole agent for the induction and maintenance of general anaesthesia, were studied in 14 healthy unpremedicated patients. Subarachnoid anaesthesia was established before induction of general anaesthesia. Induction was with propofol 2.5 mg kg-1 given while the patients breathed 100% oxygen. We intended to start an infusion of propofol 100 micrograms kg-1 min-1; maintain it for at least 25 min; make a first set of quasi-steady-state observations; double the infusion; and repeat observations after 25 min. The single induction bolus plus single rate infusion was not totally satisfactory: further boluses were usually needed. At induction there was apnoea in all but three patients, sometimes lasting more than 3 min; hyperventilation before induction, combined with hyperoxia, probably exaggerated this. Established ventilatory rates were generally 30% higher than awake. One patient became bradypnoeic. Tidal volume and minute ventilation, and the Tl:Ttot ratio, were reduced. Doubling the infusion rate had no clear effect on frequency or tidal volume, but it further reduced the Tl:Ttot ratio and caused an increase in PE'CO2 of 1 kPa. The ventilatory response to carbon dioxide was 58% of baseline awake control (95% confidence limits +/- 26%) at the lower infusion rate, with further slight depression when the infusion rate was doubled. Doubling the rate of infusion of propofol did not give twice the effect on ventilation, and probably is not giving twice the "depth" of anaesthesia. We cannot say if this is for pharmacokinetic or pharmacodynamic reasons.
Adult↗
Bulimia: some physiological considerations.
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Bulimia↗
Assessment of the Datex Relaxograph during anaesthesia and atracurium-induced neuromuscular blockade.
The Datex Relaxograph is a recently introduced electromyographic monitor of neuromuscular transmission. It has been assessed in patients requiring neuromuscular blockade and the results compared with those obtained simultaneously with a force transducer. There was a good correlation between the two methods of measurement for both twitch height and train-of-four ratio (correlation coefficients 0.93 and 0.97, respectively). The Datex Relaxograph proved easy to use in the clinical setting.
Anesthesia, General↗
Comparison of isoflurane and halothane in outpatient paediatric dental anaesthesia.
Isoflurane was compared with halothane as the sole supplement to anaesthesia with nitrous oxide and oxygen for outpatient dental extractions in 80 children. Induction and maintenance of anaesthesia were satisfactory with both agents, although there was a higher incidence of coughing, salivation and laryngospasm in the group receiving isoflurane. However, in contrast to predictions from the physical properties of isoflurane and halothane, immediate recovery was significantly slower in patients who had received isoflurane. Recovery was complicated by coughing in a significant number of patients in the isoflurane group. The incidence of reported complications during later recovery was similar with both agents, apart from the complaint of non-specific postoperative aches in a significant number of patients to whom isoflurane was administered.
Anesthesia Recovery Period↗
Restoration of baroreflex control of heart rate during recovery from anaesthesia.
The effects on baroreflex control of heart rate of halothane or methohexitone used to supplement 67% nitrous oxide in oxygen have been studied in 21 patients. Stable anaesthesia with either agent caused depression of baroreflex sensitivity by more than 50%. The set point of the reflex was also changed by both agents, but in opposite directions. Halothane administration resulted in slower heart rates at lower arterial pressures, whereas the infusion of methohexitone caused faster heart rates at lower arterial pressure. During recovery from anaesthesia, there was a rapid return of baroreflex sensitivity to normal and this was achieved before the patients regained consciousness, with no difference between the two groups. The reflex was reset rapidly and repeatedly during the recovery phase.
Adult↗
Peri-operative management of carcinoid syndrome using ketanserin.
This report describes the successful use of ketanserin, a 5-HT2 receptor antagonist, for the acute control of systemic blood pressure in a patient with the carcinoid syndrome, undergoing hepatic artery embolisation. Serial measurements of plasma 5-hydroxyindoles, platelet 5-hydroxytryptamine and plasma catecholamines are also given.
Aged↗
The effect of different pre-operative feeding regimens on plasma glucose and gastric volume and pH in infancy.
The effects of four different pre-operative feeding regimens were studied in 123 children below the age of one year presenting for surgery. Plasma glucose concentrations, blood acid-base values, gastric volume and gastric pH were measured before and after induction of anaesthesia. No patient was found to be hypoglycaemic and there were no significant differences in plasma glucose concentration and acid-base values between the groups. No correlation was demonstrated between the age and weight of the patients and the duration of fasting and the plasma glucose concentration. There was a significant elevation of plasma glucose concentration in all four groups after induction of anaesthesia (P less than 0.001) compared with the pre-induction level which is a reflection of the stress of blood sampling and induction of anaesthesia. Infants less than three months of age in the milk-feed group had a significantly higher gastric volume with low pH (P less than 0.05) signifying a potentially greater risk of pulmonary acid aspiration. The practice of timing the last pre-operative feed in infancy according to the infant's normal feeding pattern does not appear to increase the risk factors for pulmonary aspiration, if milk is avoided.
Acid-Base Equilibrium↗
Attitudes of a southern university human sexuality class toward sexual variance, abortion and homosexuality.
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Abortion, Induced↗