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Biomedical subjects

J W Dundee

Publications and source records attributed to J W Dundee.

At least 163 records · Page 9Linked to original sources
PubMed1981

Attempts to reduce respiratory complications following upper abdominal operations.

Respiratory complications were assessed in 85 patients following upper abdominal surgery and attempts made to decrease their frequency. There was a significant decrease in the frequency of cough, sputum and abnormal physical signs in the chest in those patients receiving warm, humidified air. On the first and third days after surgery the arterial oxygen tension of this group was greater than that of the control group while from days 1 to 5 PaO2 never decreased below 95% of its value before operation.

Abdomen↗
PubMed1981

Use of di-isopropyl phenol as main agent for short procedures.

The use of di-isopropyl phenol (Diprivan) for induction of anaesthesia was assessed in doses ranging from 1 to 3 mg kg-1. With less than 1.75mg kg-1 not all patients were anaesthetized; 2.0 mg kg-1 appeared to be a satisfactory induction dose. Involuntary muscle movement, cough and hiccup at induction were rare with any dose studied. However, the frequency of hypotension and respiratory depression were related to the dose given. Pain on injection was uncommon when the drug was given into an antecubital vein, but occurred in 39% of patients when injected to the back of the hand or wrist. Recovery was rapid, and characterized by lack of emetic sequelae. Di-isopropyl phenol 1.5 - 2.0 mg kg-1 given rapidly during reactive hyperaemia can produce anaesthesia in one arm-brain circulation time. A reaction involving flush, hypotension, cough, laryngospasm and bronchospasm occurred in one patient receiving 2.5 mg kg-1 given over 20 s.

Adult↗
PubMed1981

Comparison of atropine and glycopyrrolate in a mixture with pyridostigmine for the antagonism of neuromuscular block.

Neuromuscular block was antagonized using pyridostigmine 250 micrograms kg-1 in two groups of 50 patients; one group received atropine 20 micrograms kg-1 and the other glycopyrrolate 10 micrograms kg-1 with the anticholinesterase drug. Atropine was associated with a greater initial tachycardia than was glycopyrrolate. The subsequent bradycardia was also greater in this group, although the decreases in heart rate were smaller than those generally observed following mixtures of atropine and neostigmine. Arrhythmias were transient and required no treatment in either group. Better control of secretions was achieved with glycopyrrolate.

Adult↗
PubMed1981

Effect of a new analgesic, MR 1268, on circulatory and respiratory indices in volunteers.

MR 1268, a benzmorphan derivative with marked morphine-like properties and weaker antagonist properties was administered to six healthy male volunteers who each received MR 1268 2.5,5,10 and 20 mg i.v. in random order. There were no significant changes in the cardiovascular indices measured. However, significant and dose-related decreases in expired minute volume were observed. With 20 mg, consistent increases in Paco2 coincided with maximum decrease in ventilation, indicating some degree of alveolar hypoventilation. Drowsiness was dose-related but of short duration and only significant with 20 mg. Pupillary size and reaction remained unaffected.

Adult↗
PubMed1981

Liver enzyme studies with continuous intravenous anaesthesia.

A battery of liver function tests was carried out before operation and on the 3rd--5th and 13th--15th postoperative days in patients anaesthetised with continuous infusion of thiopentone, Althesin or etomidate for an intermediate operation. Some derangement of enzyme activity was found in one quarter to one third of the patients, and was most marked after Althesin. The findings are compared with published data on ketamine, which had an effect on enzyme activities similar to that of Althesin. On pooling data from different studies it became very apparent that large doses of intravenous anaesthetics cause a greater derangement of liver function than that which occurs using a balanced technique for the same operation.

Adult↗
PubMed1981

Cimetidine in elective Caesarean section. Effect on gastric acidity.

Aspiration pneumonitis, Mendelson's syndrome, continues to be an important cause of maternal morbidity and mortality in obstetric anaesthesia, despite widespread adoption of the practice of routine administration of alkalis. Histamine H2 receptor blocking drugs have been shown to reduce gastric secretion in non-obstetric patients. Cimetidine was given intravenously to fasting patients before elective Caesarean section. In all 10 patients who received cimetidine 200 mg intravenously at 60--80 minutes before anaesthesia, the pH of gastric contents at the time of induction was above 2.5. When the interval between administration of the drug and induction of anaesthesia was only 30--40 minutes (six patients) or was over 90 minutes (20 patients) then the pH was raised to above this value in only two-thirds of patients. By contrast eight of 10 untreated patients were found to have a gastric pH of less than 2.5. No adverse effects of cimetidine were seen in mothers or infants.

Anesthesia, General↗
PubMed1981

Evaluation of midazolam as an intravenous induction agent.

Midazolam, a new water-soluble benzodiazepine, was investigated as an intravenous anaesthetic agent in 260 adult patients in doses ranging from 0.15 to 0.5 mg/kg using a variety of premedications. Its onset of action was generally slow, taking up to 3 minutes to exert its maximum effect. A wide variability in response was found in that some unpremedicated patients were satisfactorily anaesthetised with 0.15 mg/kg while other were only moderately sedated following doses of 0.5 mg/kg. Less variability was found in the elderly who also required smaller doses. Narcotic premedication potentiated the sedative effect of midazolam. Few respiratory or cardiovascular effects were noted apart from hiccough following the larger doses. The incidence of venous sequelae was much lower than that found following diazepam.

Adolescent↗
PubMed1981

Effects of intravenous administration of glycopyrrolate and atropine in anaesthetised patients.

The effects of glycopyrrolate in doses of 5, 10 and 15 microgram/kg and atropine 10, 20 and 30 microgram/kg on heat rate and rhythm was studied in anesthetised patients. Both drugs produced a dose-related increase in heart rate. Glycopyrrolate was approximately twice as potent as atropine in increasing heart rate. The average time taken to achieve peak effect was 2-6 and 3-7 minutes for atropine and glycopyrrolate respectively, and this was significantly different. The smallest doses of both drugs were generally associated with supraventricular dysrhythmias, whereas these were mainly ventricular following the highest dose of both drugs.

Adult↗
PubMed1981

The placental transfer of cimetidine.

The placental transfer of cimetidine 200 mg intravenously was investigated in 16 patients in normal labour and 40 patients undergoing elective Caesarean section. Cimetidine crosses the placental barrier, blood levels at delivery in mothers and infants being lower with increasing time from injection. Umbilical cord blood cimetidine levels are markedly lower than those of the mother during the first hour following administration but thereafter levels are similar. The mean fetal-maternal ratio at delivery was highest (0.84) at 1 1/2-2 hours following administration. Postdelivery infant and maternal blood samples showed that cimetidine could not be detected, in most cases, 19 hours following administration. The relevance of these findings is discussed.

Cesarean Section↗
PubMed1981

Minaxolone: an evaluation with and without premedication.

Minaxolone, a water-soluble steroid intravenous anaesthetic, has been used in clinical trials for induction and maintenance in patients presenting for minor operations. A standard induction dose of 0.5 mg/kg was given. There was a low incidence of pain on injection and venous sequelae. Excitatory effects occurred commonly at induction but these were reduced by opiate premedication. The frequency of uneventful induction was significantly greater when the 5 mg/ml solution of minaxolone was given at a rate of 6 ml/minute than at a rate of 24 ml/minute. Minaxolone has been withdrawn from clinical trials following equivocal toxicological findings in rats which require further investigation.

Adult↗
PubMed1981

Prospective study of liver function following repeat halothane and enflurane.

In a prospective study of liver function following repeat anaesthesia, patients who received repeat halothane had a higher frequency of abnormal liver enzyme results than a similar group who received repeat enflurane. Obesity and short intervals between administrations increased the likelihood of abnormal liver enzyme activity in the halothane group. Enflurane would seem to be the volatile agent of choice for repeat anaesthesia in such circumstances.

Adult↗
PubMed1981

Reversal of neuromuscular blockade: dose determination studies with atropine and glycopyrrolate given before or in a mixture with neostigmine.

Glycopyrrolate and atropine were studied in doses of 5, 10, or 15 microgram/kg and 10, 20, or 30 microgram/kg, respectively, given intravenously either before or in a mixture with neostigmine, 50 microgram/kg, at the time of reversal of neuromuscular block. When given first, both anticholinergic drugs produced a dose-related increase in heart rate; following the administration of neostigmine the heart rates decreased. When administered in a mixture with neostigmine, the 20- and 30-microgram/kg doses, but not the 10-microgram/kg dose of atropine were associated with an initial increase in heart rate. This was, however, absent with all the doses of glycopyrrolate. The 5-microgram/kg dose of glycopyrrolate and 10-microgram/kg dose of atropine given either before or in a mixture with neostigmine were associated with unacceptable decreases in heart rate and needed further anticholinergic drug administration. The 10-microgram/kg dose of glycopyrrolate, when administered in a mixture with neostigmine, was associated with the most stable heart rates. Increasing the dose to 15 microgram/kg was not associated with undue tachycardia and is not hazardous. Atropine, 20 microgram/kg, necessitated a further administration of atropine in nearly a third of patients in this group due to bradycardia (heart rate of 50 beats/min or less) and would be considered inadequate. Increasing the dose to 30 microgram/kg prevented bradycardia but was accompanied by significant initial tachycardia and a higher incidence of dysrhythmias when administered before neostigmine. The frequency of dysrhythmias was otherwise similar. It is recommended that anticholinergic drugs be administered in a mixture with neostigmine. Glycopyrrolate, administered in this way in a dose of 10 microgram/kg, is associated with stable heart rates.

Atropine↗