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Biomedical subjects

J W Dundee

Publications and source records attributed to J W Dundee.

At least 37 records · Page 2Linked to original sources
PubMed1990

Clinical uses of P6 acupuncture antiemesis.

Having seen pregnant women pressing the P6 point as a preventative for morning sickness, stimulation of this point for 5-10 minutes by invasive (manual or electrical acupuncture) or non-invasive (transcutaneous electrical stimulation or acupressure) means was studied as an antiemetic. In well controlled studies it was shown that acupuncture administered before the opioid premedication significantly reduced postoperative sickness for 6-8 hours. Non-invasive methods were effective for a shorter period of time, with nausea and/or vomiting often occurring after 2 hours. To be effective the treatment has to be given before the opioid. Its effect can be abolished by local anesthesia. Stimulation of a dummy point near the elbow is ineffective. While acupressure reduces morning sickness, the pressure has to be applied for 5 minutes every 2 hours. There is probably a large psychological element in this. The most rewarding results are obtained when P6 stimulation is used in conjunction with standard antiemetics before cancer chemotherapy. Here again the invasive approach is more effective than non-invasive. Recent studies have involved self-stimulation using a portable battery-operated square wave stimulator fixed at 10 Hz, and a large EKG surface electrode on the P6 point. Stimulation is applied for 5 minutes every two hours. While modern antiemetics can control vomiting, they are relatively ineffective against nausea, but this can be controlled by regular use of the stimulator. The results are most promising.

Acupuncture Points↗
PubMed1990

Belfast experience with P6 acupuncture antiemesis.

In a strictly controlled clinical situation, (postoperative sickness) where variables were reduced to a minimum, it was possible to demonstrate an effective prophylactic antiemetic action of P6 (Neiguan) acupuncture. Manual and electrical invasive (needling) stimulation of this point were equally effective. Non-invasive stimulation (transcutaneous electrical or pressure) was effective in the early postoperative period, but the effect did not last as long as for invasive acupuncture--although it was as good as standard antiemetics. Stimulation of a "dummy" acupuncture point was ineffective as was administration of the acupuncture after the emetic stimulus (opioid). This effect can be blocked by local anaesthesia at the P6 point. Acupressure (P6) is moderately effective in reducing morning sickness, but here there is more of a psychological element as pressure on a "dummy" point gives some alleviation of symptoms. Given in conjunction with standard antiemetics, P6 acupuncture is a useful adjuvant in reducing sickness after cancer chemotherapy. This effect can be prolonged for 24 hours by acupressure.

Acupuncture Points↗
PubMed1989

Effect of stimulation of the P6 antiemetic point on postoperative nausea and vomiting.

The antiemetic action of stimulation of the P6 (Neiguan) acupuncture (ACP) point has been studied in women, premedicated with nalbuphine 10 mg, undergoing minor gynaecological operations under methohexitone-nitrous oxide-oxygen anaesthesia. Invasive ACP--manual or electrical at 10 Hz--applied for 5 min at the time of administration of the premedication markedly reduced the incidence of vomiting and nausea in the first 6 h after operation, compared with untreated controls. This did not occur with stimulation of a "dummy" ACP point outside the recognized ACP meridians. Non-invasive methods (stimulation via a conducting stud or by pressure) were equally as effective as invasive ACP during the early postoperative period. However, both these non-invasive approaches were less effective than invasive ACP in the 1-6 h postoperative period, although each was as effective as two standard antiemetics (cyclizine 50 mg, metoclopramide 10 mg). In view of the total absence of any side effects in more than 500 ACP procedures, the clinical applications of this finding are worthy of further study.

Acupuncture Points↗
PubMed1989

Acupuncture prophylaxis of cancer chemotherapy-induced sickness.

In a multi-facet study we evaluated the efficacy of P6 electroacupuncture (10 Hz applied for 5 min) as an antiemetic in patients receiving a variety of cancer chemotherapy drugs. The study involved 130 (15 in an open pilot study, 10 in a randomized placebo controlled crossover study and 105 in a definitive study) patients who had a history of distressing sickness after previous treatment, and who, on the basis of a previous survey, would be expected to have a 96% chance of this with subsequent therapy. Sickness was either completely absent or reduced considerably in 97% of patients and no side effects were encountered. The limited crossover study, using a 'dummy' acupuncture (ACP) point showed that the beneficial effects were limited to the P6 point. Logistic and ethical considerations excluded the possibility of carrying out a larger placebo-controlled study. While in our hands P6 ACP was an effective antiemetic in patients having cancer chemotherapy, because of the time involved and the brevity of the action (8 h) an alternative approach to electro-ACP is required before this technique is adopted clinically.

Acupuncture Therapy↗
PubMed1989

Use of auditory evoked responses as a measure of recovery from benzodiazepine sedation.

The amplitude of the P300 component of auditory evoked responses was found to be depressed by benzodiazepine sedation and was subsequently used to monitor the recovery of volunteers sedated with midazolam. The amplitude of the evoked responses was found to be highly correlated with blood midazolam levels but to be no more sensitive than standard psychomotor testing in assessing recovery from sedation.

Adult↗
PubMed1989

Propofol.

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Anesthetics↗
PubMed1988

Postoperative gastric emptying in outpatient anesthesia: the effect of opioid supplementation.

Acetaminophen (paracetamol) 20 mg/kg was administered orally to 45 gynecological outpatients who had received either alfentanil 5 micrograms/kg, fentanyl 1 microgram/kg, or no analgesic supplement immediately prior to the induction of general anesthesia. Postoperative gastric emptying, assessed by acetaminophen absorption, was significantly inhibited in those given alfentanil. This inhibition is unlikely to be of great clinical importance and was much less than that found in previous studies using longer-acting opioids such as morphine.

Absorption↗
PubMed1988

A pharmacokinetic study of midazolam in paediatric patients undergoing cardiac surgery.

Midazolam 0.3 mg kg-1 was given as a single dose to three groups of children undergoing cardiac surgery to determine its pharmacokinetic profile in this situation. The first group, undergoing closed heart surgery, received the midazolam during the operation. The other groups underwent cardiopulmonary bypass (CPB) with and without complete circulatory arrest. Mean clearance was 512 ml kg-1 h-1 and mean elimination half-lives were 3.3 h following CPB, with a tendency to a higher clearance in those children who had not undergone bypass. In a subsequent part of the study, 10 children received an infusion of midazolam 0.05 mg kg-1 h-1, in combination with intermittent doses of morphine, in the postoperative period. Mean plasma midazolam concentrations consistent with adequate sedation were 80-100 ng ml-1 during the infusion. One child who had not undergone CPB had very low plasma concentrations of midazolam with the same rate of infusion, consistent with the tendency for higher clearance in this group in the bolus pharmacokinetic study.

Cardiac Surgical Procedures↗
PubMed1988

The effects of thiopentone and propofol on upper airway integrity.

One hundred and fifty-eight unpremedicated patients scheduled for elective surgery were allocated randomly to receive an unsupplemented induction dose of thiopentone or propofol. Visualisation of the vocal cords by standard laryngoscopy was possible more often after propofol (p less than 0.01). Pharyngeal and laryngeal reactivity was similarly depressed more frequently.

Adult↗
PubMed1988

Halothane and isoflurane in outpatient anaesthesia. A comparison of recovery.

The speed and quality of recovery after anaesthesia were studied in 60 outpatients. Anaesthesia was induced using propofol and maintained by nitrous oxide in oxygen supplemented with either halothane or isoflurane. Initial clinical recovery was significantly faster in the halothane group but no differences were found during subsequent psychomotor testing. Minor postoperative side effects were common in both groups.

Adolescent↗
PubMed1988

Plasma concentrations of bupivacaine during extradural anaesthesia for caesarean section. The effect of adrenaline.

The clinical effects and plasma levels associated with the use of 0.5% bupivacaine with and without the addition of 1:200,000 adrenaline (5 micrograms/ml) were studied in 30 patients who underwent extradural anaesthesia for elective Caesarean section. The addition of adrenaline to bupivacaine prolongs analgesia, reduces the degree of hypotension and delays its onset. Plasma bupivacaine levels were consistently lower when adrenaline was added, but this difference was significant only at 10 minutes after the initial dose. Prolonging the interval between increments seems to be a more reliable way to reduce plasma concentration than the addition of the catecholamine.

Anesthesia, Epidural↗
PubMed1988

The antiemetic action of propofol.

Eighty patients who underwent minor gynaecological surgery were anaesthetised with either incremental propofol or incremental methohexitone after an opioid premedication. The group anaesthetised with propofol had significantly fewer emetic sequelae and the results suggest that propofol has a definite antiemetic action.

Adult↗