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Biomedical subjects

J G Hannington-Kiff

Publications and source records attributed to J G Hannington-Kiff.

At least 19 recordsLinked to original sources

Sumatriptan relieves and prevents peri-operative migraine attacks.

The novel use of sumatriptan as an adjunct to the management of general anaesthesia in patients with a history of migraine is described. In two unpremedicated patients awaiting day surgery an acute pre-operative attack of migraine was successfully terminated by the injection of sumatriptan, allowing surgery to proceed uneventfully under general anaesthesia without postoperative complications. Two other patients with a history of severe habitual vomiting after general anaesthesia, who also had a history of migraine, were each given a prophylactic injection of sumatriptan after induction of anaesthesia and for the first time emerged from general anaesthesia free of these distressing complications.

Adult

Topical guanethidine relieves dentinal hypersensitivity and pain.

The topical application of guanethidine solution to the affected teeth has been successful in relieving natural and clinically induced dentinal pain and hypersensitivity in 13 of 14 dental patients in a pilot study. The mechanism of this analgesia was unclear but probably involved anti-noradrenergic block as there was no evidence of local anaesthesia. Further studies may generate new ideas about the cause of the excruciating pain and hypersensitivity often associated with the acute exposure of tooth dentine and lead to new ways of managing the discomforts of dental conservation and restoration.

Administration, Topical

Does failed natural opioid modulation in regional sympathetic ganglia cause reflex sympathetic dystrophy?

Early features of reflex sympathetic dystrophy in a limb resemble the general effects of autonomic arousal associated with opioid withdrawal. It is suggested that natural opioid peptide modulation in regional sympathetic ganglia normally rises to prevent excessive autonomic activity in an injured limb. After an injury (especially a trivial one) to a susceptible subject, this localised increase in opioid modulation may fail or may rapidly wane so that autonomic features of opioid withdrawal appear in the affected limb. Florid dystrophic changes may then occur because of passive complications of disuse associated with pain, or as a result of more active processes. Preservation of an appropriate opioid bias in the regional sympathetic ganglia might be an important factor in the successful management and prevention of reflex sympathetic dystrophy.

Autonomic Nerve Block

Faulty Superset plastic catheter mounts. A cautionary tale applicable to other mass-produced disposable products.

Nine Superset (Intersurgical Ltd) single-use corrugated plastic catheter mounts were found to be faulty in a boxed batch of 75. The manufacturer's meticulous system of batch coding enabled the source of the problem to be traced quickly. Sporadic faults must be expected to occur in mass-produced disposable equipment and the unusual origin of the defect reported in these catheter mounts is testimony to the way unexpected events can prejudice the most carefully regulated quality control. It is emphasised that the user can help safeguard the community by ensuring that stock is used in strict rotation and that batch numbers are accurately reported when faults arise.

Anesthesiology

Bier's block revisited: intercuff block.

Bier introduced his intravenous technique of local anaesthesia to facilitate palliative surgery on the elbow or knee. He cannulated a suitably large vein in the vicinity of the joint to inject procaine after first isolating the operating site with a proximal and a distal tourniquet. This extra containment of the local anaesthetic solution made it feasible to flush out any unfixed drug with saline before release of the main tourniquet, an advantage which has been lost in the currently fashionable technique of intravenous regional anaesthesia (IVRA) involving a single tourniquet above the elbow or knee and a fine butterfly needle in a vein on the dorsum of the hand or foot. A modern version of Bier's original method is described, conveniently called an intercuff block (ICB), which reintroduces the possibility of effective flushing, offers better operating conditions and engenders new ideas for further study.

Adult

The need for analgesic cover after ENT surgery--comparison of nefopam and papaveretum.

Intra-operative intramuscular injections of either papaveretum 0.3 mg/kg or nefopam 0.4 mg/kg were given to alternate patients to promote smooth emergence from ENT anaesthesia in a consecutive series of 40 children. Observations over a period of 30 minutes following completion of surgery showed that emergence was satisfactory in 19 out of 20 children given papaveretum, and in 15 out of 20 children given nefopam. The study confirms that this indication for papaveretum is justifiably popular and that nefopam is a useful alternative mainly because it does not cause respiratory depression. There are no previous reports of the use of nefopam in children.

Child