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Biomedical subjects

J D Oates

Publications and source records attributed to J D Oates.

7 recordsLinked to original sources

Memory for auditory material presented during anaesthesia.

We have assessed postoperative memory for lists of 10 neutral words, presented by tape recording, in patients anaesthetized by a standardized technique comprising thiopentone 5 mg kg-1, midazolam 0.07 mg kg-1, fentanyl 3 micrograms kg-1 and 70% nitrous oxide in oxygen, using both free recall and a test in which the subject was asked to indicate the presented words from a larger list. Twenty-four patients were exposed to one of four tape-recorded lists of words and 24 were presented with a blank tape. There was no instance of free recall of presented words. Analysis of the responses in the implicit memory test revealed no difference between the performance of the patients who had been exposed to a word list and those who had not.

Adult↗

Failure of pain relief after surgery. Attitudes of ward staff and patients to postoperative analgesia.

Three surveys of postoperative patients and surgical ward staff were conducted in an 840-bed university hospital to ascertain the severity of pain after surgery and the reasons why patients in pain do not receive more of the analgesia prescribed for them. In the first survey, 206 inpatients were questioned within 24 h following operation, and 25.2% of patients experienced moderate pain whilst 9.2% experienced severe pain but received only 36% of their prescribed analgesics. In the second survey, 176 staff reported that the commonest reasons why patients in pain did not receive analgesics were that they did not request analgesia, were too sleepy or refused the dose. In the final survey, of 200 inpatients questioned, 88% had experienced pain since operation, 97% had been offered analgesics, 14% refused a dose. Twenty-nine percent were moderately or very concerned about injections. The beliefs of both ward staff and patients could have contributed to this failure of pain relief.

Adolescent↗

Efficacy of orally administered ondansetron in the prevention of postoperative nausea and vomiting: a dose ranging study.

In a placebo-controlled, double-blind study, we have compared the efficacy of ondansetron 16 mg, 8 mg and 1 mg administered 8-hourly for prevention of postoperative nausea and vomiting. We studied 995 patients undergoing major gynaecological surgery; 982 were included in the analysis. Study medication was administered 1 h before induction of anaesthesia and second and third doses were given 8 and 16 h after the first. The treatment groups were similar for patient characteristics, surgical procedures, anaesthetics administered and opioids given. The frequency of nausea was 75%, 70%, 56% and 55% after placebo and ondansetron 1 mg, 8 mg and 16 mg, respectively; the corresponding frequencies of vomiting were 60%, 55%, 37% and 37%. Ondansetron 8 mg was as effective as 16 mg and both resulted in significant reductions in nausea and vomiting compared with placebo and ondansetron 1 mg (P less than 0.001).

Administration, Oral↗

Comparison of two methods for predicting difficult intubation.

Two methods of predicting difficult laryngoscopy were compared prospectively. Mallampati class and Wilson risk-sum were determined before operation and laryngeal view graded in 675 patients. Both tests identified five of 12 difficult laryngoscopies; twice as many patients were predicted to be difficult by Mallampati classification than by Wilson risk-sum. Inter-observer variation was minimal using Wilson risk-sum, but considerable for Mallampati classification. We prefer the Wilson risk-sum for assessment of the airway, while noting that both tests have poor sensitivities.

Adolescent↗

Fatal infantile form of muscle phosphofructokinase deficiency.

We studied a girl with an infantile syndrome of limb weakness, seizures, cortical blindness, and corneal opacifications; she died at age 7 months of respiratory failure. There was no consanguinity or family history of neuromuscular diseases. Histochemical and biochemical studies of muscle showed mildly increased glycogen content and markedly decreased PFK activity (1.4% of the normal mean). Anaerobic glycolysis in vitro confirmed the metabolic block. Immunofluorescence and immunotitration by ELISA using monoclonal antibodies against subunit M of PFK showed a normal amount of cross-reacting material. The brain showed typical features of neuroaxonal dystrophy. This variant of PFK deficiency may be due to a distinct genetic defect.

Brain Diseases↗

Laboratory-acquired Campylobacter enteritis.

A case of gastroenteritis occurred in a laboratory worker 2 1/2 days after exposure in the laboratory to a culture of Campylobacter fetus ss jejuni. Spontaneous recovery was complete after 1 1/2 weeks.

Adult↗