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Biomedical subjects

J W Dundee

Publications and source records attributed to J W Dundee.

At least 127 records · Page 7Linked to original sources
PubMed1983

Intramuscular and oral midazolam. Some factors influencing uptake.

Intramuscular midazolam is better absorbed than when given orally. Addition of hyaluronidase to the injection significantly increases uptake but causes a high incidence of pain at the injection site. Concurrent administration of oral midazolam and metoclopramide does not increase its uptake.

Absorption↗
PubMed1983

Ranitidine as an antacid before elective Caesarean section.

In a preliminary study, 20 women in labour received ranitidine 50 mg intravenously. No significant changes were seen in the height, frequency or amplitude of uterine contractions or in fetal heart rate or pattern. No neonatal problems attributable to ranitidine were found. Ranitidine crossed the placenta, the mean fetal-maternal ratio being 0.9. Levels in the infants 12 hours following delivery were all very low. Ranitidine 150 mg orally was given to 80 healthy women undergoing elective Caesarean section at varying times from 75 to 510 minutes pre-operatively. From 2 to 6 hours following ingestion, the pH of gastric contents was greater than 2.5 in all but one patient. The mean volume aspirated (8 ml) was significantly lower than in a control group receiving magnesium trisilicate (mean volume 30 ml). Neonatal assessment included Apgar scoring, neurobehavioural examination, feeding progress, measurement of acidity and culture of gastric aspirates. No significant differences between groups were found. Blood levels indicated that the oral drug is readily absorbed by the parturient and that a smaller proportion is transferred to the fetus, mean fetal-maternal ratio at delivery being 0.38.

Adult↗
PubMed1983

Continuous intravenous anaesthesia with Althesin for resection of tracheal stenosis.

The anaesthetic management of patients undergoing tracheal resection for tracheal stenosis and the advantage of the maintenance of spontaneous respiration without intubation of the distal tracheal segment is discussed. The case reports of two such patients using a continuous intravenous infusion of Althesin with maintenance of spontaneous respiration are presented. The technique expedited the surgical reanastomosis due to lack of instrumentation in the surgical field. While some mild respiratory depression as evidenced by carbon dioxide retention did occur, the technique is worthy of consideration for the procedure.

Adolescent↗
PubMed1983

Ranitidine influences the uptake of oral midazolam.

In a randomised crossover study in volunteers plasma midazolam levels were estimated for 24 h following 15 mg by mouth, either preceded by no medication or following 24 h therapy with ranitidine. Administration of the H2-receptor blocker significantly increased bioavailability of the benzodiazepine and resulted in higher plasma levels for the first 6 h after taking midazolam. This was accompanied by a greater soporific effect.

Benzodiazepines↗
PubMed1983

Dose-finding and premedication studies with zopiclone.

The new non-benzodiazepine hypnotic, zopiclone, was investigated as a preanaesthetic medication in a randomized, double-blind, placebo-controlled study in healthy patients scheduled for minor gynaecological surgery. Initially a dose-finding study was conducted in which zopiclone 3.75 mg, 7.5, and 11.25 mg was compared with diazepam 10 mg and placebo; 7.5 mg was established as the optimum dose of zopiclone. In the main study zopiclone 7.5 mg was comparable to diazepam 10 mg at 20, 40, and 60 min after administration and more efficacious at 90 min.

Adult↗
PubMed1983

Use of cimetidine as an oral antacid in obstetric anesthesia.

The H2-receptor antagonist, cimetidine, was used instead of magnesium trisilicate BPC as routine antacid therapy before both elective and emergency obstetric anesthesia. Two trials of its efficacy in increasing intragastric pH and decreasing the volume of gastric contents in parturients are reported. In the first trial, 400 mg of cimetidine given orally to patients being delivered by elective cesarean section effectively decreased gastric acidity, providing induction of anesthesia occurred 90-150 min after its administration. Of 62 patients requiring emergency anesthesia during active labor and who had been treated with 200 mg of cimetidine orally at 2-h intervals, 80% had gastric contents with a pH higher than 2.5. Failure to decrease gastric acidity to this level was mainly due to anesthesia being required within 60 min of the loading dose, but it also was considered that inaccurate timing of repeat doses and possibly delay in uptake due to gastric stasis by narcotic analgesia played a part. In trial 2 the same cimetidine regimen plus a 15-ml oral dose of 0.3 M sodium citrate given 10 min before induction of anesthesia was studied. All 72 women delivered by elective cesarean section had a low volume of gastric contents with pH greater than 2.5. Only 4% of 135 patients requiring emergency anesthesia had gastric aspirates the pH of which was less than 2.5. The volume (97 +/- 8.4 ml) of gastric contents removed from the latter patients were considered to still pose a hazard at induction of general anesthesia. No maternal or infant side effects related to cimetidine therapy were noted.

Administration, Oral↗
PubMed1983

Post-thoracotomy pain relief: combined use of cryoprobe and morphine infusion techniques.

In a reported study we found that freezing of the intercostal nerves under direct vision at thoracotomy provided better postoperative analgesia than im morphine on demand. Infusions of morphine were also more effective than when used by the intramuscular route. The benefit on the eighth postoperative day was greatest following the use of the cryoprobe. Further studies were carried out to evaluate the benefit of combining 'cryoprobe' analgesia with infusions of morphine. The combined use of morphine infusion and a cryoprobe did not produce greater postoperative pain relief than the use of the cryoprobe alone with im morphine on demand.

Adult↗
PubMed1982

I.m. or i.v. atropine or glycopyrrolate for the prevention of oculocardiac reflex in children undergoing squint surgery.

The frequency and nature of the oculocardiac reflex and its prevention by atropine or glycopyrrolate (i.m. and i.v.) has been studied in 160 children undergoing surgery for the correction of squint. Ninety per cent of those given no anticholinergic premedication exhibited the reflex. This was decreased to about 50% in those receiving the drugs i.m. Glycopyrrolate 7.5 micrograms kg-1 and atropine 15 micrograms kg-1 i.v. were effective in most instances, the latter being slightly better. However, glycopyrrolate was associated with tachycardia of smaller magnitude. The reflex was observed more often following traction on the medial rectus muscle.

Adolescent↗
PubMed1982

Effect of preanaesthetic medication on anaesthesia with ICI 35, 868.

The effect of three commonly used premedicants and a control on anaesthesia with ICI 35, 868 is described. Two randomized studies were performed--one a group study of induction characteristics at 2 mg kg-1 and the other a detailed study in patients undergoing minor gynaecological surgery with an induction dose of 1.5 mg kg-1 and maintenance with incremental doses plus 66% nitrous oxide in oxygen. Premedication had little effect on the already good induction characteristics. Only heavy opiate premedication produced reliable induction at 1.5 mg kg-1, but with an increase in side-effects. Diazepam appears to be the premedicant of choice, although the overall frequency of pain on injection has not been affected by premedication.

Adolescent↗
PubMed1982

Comparison of the effect of diisopropyl phenol (ICI 35, 868) and thiopentone on response to somatic pain.

The response to somatic pain with sub-hypnotic doses of ICI 35, 868 (diisopropyl phenol in cremophor) and thiopentone was compared using tibial pressure algesimetry. Studies were also carried out following recovery from larger doses of both drugs. The patients underwent gynaecological procedures using only one of the two i.v. agents and nitrous oxide in oxygen. The studies confirmed the known antanalgesic action of thiopentone and demonstrated that diisopropyl phenol has an analgesic action which is an attractive feature in an i.v. anaesthetic agent.

Anesthesia, Intravenous↗
PubMed1982

Cimetidine as an oral antacid before elective Caesarean section.

The H2-receptor antagonist cimetidine was used as a pre-operative antacid in 64 women scheduled for elective Caesarean section. All were given cimetidine 400 mg 90-215 minutes before induction, with 20 of them having an extra 400 mg dose the previous night. The intragastric pH at induction of anaesthesia was reliably above 2.5 if the treatment was given 90-150 minutes beforehand. The volume of gastric contents was reduced when compared with a control series of women receiving either no pre-operative antacid or 30 ml magnesium trisilicate mixture BPC. No adverse effects on mothers or infants were detected.

Adult↗
PubMed1982

A field trial of cimetidine as the sole oral antacid in obstetric anaesthesia.

Cimetidine was used as the routine antacid treatment for 1323 parturients. The findings from 70 of those who needed an emergency general anaesthetic are reported. Once sufficient time had elapsed for absorption of the drug, and provided that the dosage regime was adhered to, 96% of the women studied had an intragastric pH above 2.5. Neonatal monitoring revealed no abnormalities related to the cimetidine treatment.

Anesthesia, Obstetrical↗