Quality assurance: its effect in practice.
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Anesthesia, Obstetrical↗
Biomedical subjects
J Paull
Publications and source records attributed to J Paull.
Differences in the binding of quinine and quinidine to plasma proteins.
1. Little is known about the comparative plasma protein binding of the antimalarial agents quinine (QN) and its isomer quinidine (QD). We have examined the in vitro binding of QN and QD to albumin, alpha 1-acid glycoprotein, normal human plasma, and maternal and foetal umbilical cord plasma. 2. QN was more avidly bound than QD, and binding of both drugs was substantially higher to alpha 1-acid glycoprotein than to albumin, indicating that alpha 1-acid glycoprotein is the more important binding protein. 3. Protein and drug concentration dependent binding was evident for both QN and QD. The unbound fraction of both drugs fell with increasing albumin (10 to 60 g l-1) and alpha 1-acid glycoprotein (0.5 to 2.0 g l-1) concentration, and there was a marked increase in unbound fraction of QN (6 to 19%) and QD (13 to 36%) in human plasma when drug concentrations were increased over the antimalarial therapeutic range (0.5 to 10 mg l-1). 4. In human volunteer plasma, the unbound fractions of QN and QD were 7.5 +/- 2.2% and 12.3 +/- 2.3% respectively, whilst the unbound fractions for both drugs were significantly higher in maternal plasma (QN = 13.0 +/- 5.4%, QD = 18.3 +/- 2.5%) and significantly higher still in foetal umbilical cord plasma (QN = 25.7 +/- 10%, QD = 35 +/- 5.3%).
Adult↗
The management of severe preeclampsia with intravenous magnesium sulphate, hydralazine and central venous catheterization.
A prospective study of patients with severe preeclampsia managed by magnesium sulphate infusion for eclampsia prophylaxis, hydralazine infusion for vasodilatation and central venous catheterization for fluid monitoring is reported. In this preliminary report of 46 patients, there was no episode of eclampsia following treatment, no maternal death, and hypertension was well controlled in all patients. Of the 51 babies born, there were 7 stillbirths, and 4 neonatal deaths; 6 of the 7 stillbirths were less than 30 weeks' gestation, and 23 of the 46 patients were delivered by Caesarean section.
Acute Disease↗
A prospective study of dextran-induced anaphylactoid reactions in 5745 patients.
A prospective study of dextran-induced anaphylactoid reactions (DIAR) in 5745 gynaecological and obstetric patients who received dextran 70 solution intravenously while undergoing major surgery revealed 8 patients who had Grade I or II reactions and 7 patients who had Grade III or IV reactions. The incidence of severe reactions was 1:821 patients treated. The overall incidence of reactions per patient treated was 1:383. One neonatal death followed a dextran-induced cardiac arrest in a woman about to undergo caesarean section. The risks of dextran 70 treatment exceeded the risks of thromboembolism in these patients.
Adult↗
Anaesthetic machines and monitoring equipment.
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Anesthesiology↗
Misleading gauges.
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Anesthesia, Inhalation↗
Evaluating fetomaternal hemorrhage by alphafetoprotein and Kleihauer following therapeutic abortions.
In a survey of 75 patients at 6-11 weeks gestation, fetomaternal hemorrhage (FMH) was detected by significant rises (greater than 2 S.D.) in maternal alphafetoprotein (AFP) levels in 57% of patients, while increased fetal cells were detected by the Kleihauer test in 24% of patients. With increasing gestation, FMH was detected more readily by both tests; however, in evaluating FMH at less than 10 weeks gestation. AFP was found to be a more sensitive and reliable marker than the Kleihauer test. We suggest that there is a gray zone for the Kleihauer test in early gestation, when erythroblasts containing embryonic hemoglobins are gradually replaced in the fetal circulation by erythrocytes containing fetal hemoglobin.
Abortion, Therapeutic↗
The pleasure of personal discovery.
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Anesthesiology↗
Selecting a computer for your needs.
Realistic goals and adequate information about equipment and program capabilities are essential prerequisites when selecting a computer system. Problems of equipment selection are dealt with by discussing a range of microcomputers emphasising the need to consider expansion and compatibility with standards such as the S. 100 bus. The importance of ready availability of word processing and management programs is emphasised.
Anesthesiology↗
Drugs in obstetric anaesthesia.
From the anaesthetist's viewpoint, pharmacokinetics of pregnancy, drugs affecting uterine muscle tension and foetal effects of anaesthetic drugs are reviewed.
Albuterol↗