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Biomedical subjects

K M Sherry

Publications and source records attributed to K M Sherry.

At least 37 records · Page 2Linked to original sources
PubMed1993

A combined chest drain and intrapleural catheter for post-thoracotomy pain relief.

This study examined the effectiveness of a new type of chest drain, which incorporates an additional lumen within its wall to facilitate the administration of intrapleural bupivacaine. Nine patients who received a bolus dose of 1.5 mg.kg-1 bupivacaine with 1:200,000 adrenaline through this chest drain used less morphine, and had lower visual analogue pain scores in the first 6 h after thoracotomy than patients in whom a standard chest drain had been used. Bupivacaine levels were found to be within safe limits in all patients.

Bupivacaine↗
PubMed1992

Milrinone in the treatment of low output states following cardiac surgery.

Milrinone is known to have beneficial haemodynamic and clinical effects in patients with congestive heart failure. An investigation into the safety and efficacy of milrinone in patients following heart surgery was undertaken by the European Milrinone Multicentre Trial Group. This paper reports the efficacy, the effects on left heart function, and the adverse events in the study. Ninety-nine adult patients, 61 coronary artery bypass grafting (CABG), 33 valve surgery (VS), and five CABG+VS were studied. Three dosage regimens were investigated sequentially. All patients received a loading dose of intravenous milrinone 50 micrograms kg-1 over 10 min, followed by an infusion of either 0.375 micrograms kg-1 min-1, 0.5 microgram kg-1 min-1, or 0.75 microgram kg-1 min-1 over 12 h. The groups were comparable for age, weight, and surface area; however, in the group receiving 0.5 microgram kg-1 min-1 there were more females and patients undergoing mitral valve surgery. Efficacy criteria of an increase in cardiac index of 30% and/or a decrease in mean pulmonary capillary wedge pressure of 25% were fulfilled by 77 patients at the 60-min measurement. Of the remaining 22 patients, 17 were clinically satisfactory and fulfilled efficacy criteria at some time during the study. At 15 min and 60 min there was a dose-related decrease in systolic and diastolic arterial pressure; however, there was no significant difference in the mean arterial pressure measurements. In all groups there was an improvement in cardiac index at 15 min following the start of milrinone, which was sustained during and up to 4 h after the infusion. This was closely associated with changes in stroke volume index and systemic vascular resistance, and not solely due to a change in heart rate.

Adult↗
PubMed1991

Clinical and haemodynamic effects of milrinone in the treatment of low cardiac output after cardiac surgery.

We have studied the haemodynamic effects of i.v. milrinone, a new phosphodiesterase inhibitor, in patients with low cardiac output after cardiac surgery. Thirty-five patients with a cardiac index (Cl) less than 2.5 litre min-1 m-2 and a pulmonary capillary wedge pressure (PCWP) greater than 8 mm Hg were given a loading dose of milrinone 50 micrograms kg-1 followed by an infusion at one of three rates: 0.375 micrograms kg-1 min-1, 0.5 micrograms kg-1 min-1 or 0.75 micrograms kg-1 min-1 for 12 h. After 1 h there were increases in Cl (35%) (P less than 0.001), heart rate (13%) (P less than 0.01) and stroke volume index (19%) (P less than 0.005). There were decreases in mean arterial pressure (12%) (P less than 0.01), systemic vascular resistance (35%) (P less than 0.001) and PCWP (24%) (P less than 0.05). Pulmonary vascular resistance was unchanged or reduced and left ventricular stroke work index was unchanged or increased. The haemodynamic improvements were sustained throughout the infusion period. Milrinone was tolerated well: three patients developed tachycardia greater than 125 beat min-1, one patient developed atrial fibrillation and one patient had a short run of atrial bigemini. We conclude that milrinone is a useful agent in the treatment of patients with a reduced cardiac output after cardiac surgery.

Adult↗
PubMed1991

Milrinone, a bridge to heart transplantation.

We describe the use of a milrinone infusion as a bridge to heart transplantation in the treatment of severe congestive cardiac failure secondary to viral cardiomyopathy. The clinical improvement that occurred when milrinone was commenced made it possible to wean the patient from conventional cardiovascular support with an intra-aortic balloon pump and dobutamine. There was an improvement in organ perfusion.

Cardiomyopathies↗
PubMed1991

Multicenter long-term safety and efficacy study of vigabatrin for refractory complex partial seizures: an update.

We followed 66 patients with refractory complex partial seizures and a favorable initial response to vigabatrin for 5 to 72 (median, 43) months. Thirty-seven patients discontinued vigabatrin for the following reasons: benefit-to-risk evaluation, 8; seizure breakthrough, 6; adverse events, 6; seizure breakthrough and adverse events, 5; moved or lost, 4; no longer eligible for study, 2; non-drug-related death, 2; narcotic abuse, 1; and patient request, three. There were no clinically significant abnormalities in laboratory studies including SMA 12, complete blood count, ECG, EEG, and visual evoked response testing, and no toxicity other than reversible, dose-dependent side effects. Based on this and other long-term data, clinical trials of vigabatrin have resumed in the United States and Canada.

Aminocaproates↗
PubMed1990

Pharmacokinetics of an infusion of propofol during cardiac surgery.

We have measured whole blood concentrations and pharmacokinetics of propofol administered as a constant rate infusion during cardiac surgery. Ten patients undergoing elective cardiac surgery involving cardiopulmonary bypass (seven myocardial revascularization and three aortic valve surgery) received a continuous infusion of propofol 4 mg kg-1 h-1 to supplement alfentanil analgesia. Whole blood propofol concentrations were measured by high pressure liquid chromatography. A concentration greater than 1 microgram ml-1 was achieved within 15 min of starting the infusion and remained constant throughout surgery. Volume of distribution, clearance and terminal half-life were similar to those found in non-cardiac patients.

Adolescent↗
PubMed1989

A multicentre study of vigabatrin for drug-resistant epilepsy.

1. Vigabatrin (GVG) was given in a single-blind fashion to 89 patients with complex partial seizures (CPS) refractory to conventional drugs. 2. The median number of CPS per month decreased from 11.0 to 5.0 after addition of GVG, and 51% of patients had a 50% or greater decrease in CPS frequency (P less than 0.001). 3. Side effects (principally drowsiness, ataxia, headache) occurred mainly during the initiation of therapy and decreased during therapy. After 12 weeks on GVG side effects significantly interfered with functioning in only 13% of patients, and the efficacy: toxicity ratio warranted continued administration in 74% of patients. 4. Co-administration of GVG resulted in a mean decrease of 20% in phenytoin serum concentration (P less than 0.001). 5. Sixty-six patients having a favourable response to GVG during the single-blind study have been followed for 6-54 (median 33) months on GVG. Only 17 patients have dropped out of long-term follow-up due to break through seizures and/or side effects. No serious systemic or neurological toxicity has been detected.

Adult↗
PubMed1988

Thermodilution cardiac output measurements during conventional and high-frequency ventilation.

The thermodilution method for cardiac output determinations correlates well with Fick and dye dilution methods. Experimental work with thermodilution techniques has shown that individual measurements of right heart cardiac output during conventional ventilation vary throughout the respiratory cycle. The aims of this study were to compare thermodilution cardiac output determinations made at a fixed point (zero end-expiratory pressure [ZEEP]) with those made randomly throughout the respiratory cycle during conventional controlled positive pressure ventilation (CPPV) and high-frequency jet ventilation (HFJV) with up to 10 cm H2O positive endexpiratory pressure (PEEP). There were no statistically significant differences between the cardiac output determinations made at ZEEP and randomly in the ventilation cycle in any group and all correlations were significant. The clinical implications of these results are discussed, and it is concluded that it is not necessary to time the measurements of thermodilution cardiac output determinations during CPPV or HFJV with up to 10 cm H2O of PEEP.

Adult↗
PubMed1987

Assessment of a high frequency ventilator breathing system for use in the operating theatre. An experimental and clinical study.

A breathing system capable of delivering positive pressure ventilation to the lungs at high frequencies and using anaesthetic gases and vapours is assessed. The recommended fresh gas flow at the ventilatory rates tested in this study was 100 ml kg-1. At 80 and 100 b.p.m. the system provided adequate ventilation, good oxygenation and haemodynamic stability. When compared with conventional positive pressure ventilation (CPPV), peak airway pressure (peak Paw) was lower and mean airway pressure (Paw) was lower (80 b.p.m.) or unchanged (100 b.p.m.). There was some inherent positive end-expiratory pressure (PEEP) associated with the technique.

Anesthesia, Inhalation↗
PubMed1987

A nasal adhesion following prolonged nasotracheal intubation.

A patient who presented with nasal obstruction 4 months after prolonged pernasal tracheal intubation is described. The cause of the obstruction was an adhesion which extended from the septum to the inferior turbinate. The evidence in support of long-term pernasal tracheal intubation is presented and the aetiology of this complication is discussed.

Humans↗
PubMed1987

Comparison of conventional intermittent positive pressure ventilation with high frequency jet ventilation. Studies following aortocoronary bypass graft surgery.

This study was designed to compare the cardiorespiratory effects of high frequency jet ventilation at 150 breaths/minute with and without added positive and expiratory pressure, with conventional intermittent positive pressure ventilation in 20 patients following aortocoronary bypass graft surgery. On comparison with intermittent positive pressure ventilation, there was a decrease in peak airway pressure during high frequency jet ventilation when positive and expiratory pressure of 0 or 0.5 kPa was applied, but not with 1 kPa, and an increase in mean airway pressure with positive end expiratory pressures of 0.5 and 1 kPa. On changing from intermittent positive pressure to high frequency jet ventilation with no added end expiratory pressure, there was an acute decrease in arterial oxygen tension and increases in cardiac output and total tissue oxygen delivery. On changing from intermittent positive pressure ventilation to high frequency jet ventilation with 1 kPa of positive end expiratory pressure, there was an acute decrease in arterial oxygen tension, cardiac output and oxygen delivery, and increases in pulmonary arterial, right atrial and pulmonary capillary wedge pressures. The addition of positive end expiratory pressure did not prevent the acute decrease in arterial oxygen tension which occurred on transfer to high frequency jet ventilation.

Adult↗
PubMed1987

Comparison of the haemodynamic effects of intermittent positive pressure ventilation with high frequency jet ventilation. Studies following valvular heart surgery.

The cardiorespiratory effects of intermittent positive pressure ventilation and high frequency jet ventilation with and without positive end expiratory pressure were compared in patients following valvular heart surgery (mitral and/or aortic). Twenty patients received intermittent positive pressure ventilation and high frequency jet ventilation with 0, 0.5 and 1.0 kPa positive end expiratory pressure. High frequency jet ventilation was well tolerated. The addition of 1.0 kPa positive end expiratory pressure was associated with preservation of the arterial oxygen tension without any increase in shunt or significant adverse haemodynamic effect. The results are discussed and compared with a previous study of high frequency jet ventilation following aortocoronary bypass graft surgery.

Adult↗
PubMed1987

Vigabatrin for refractory complex partial seizures: multicenter single-blind study with long-term follow-up.

The irreversible GABA transaminase inhibitor vigabatrin (VGB) was given in a single-blind fashion to 89 patients with complex partial seizures (CPS) refractory to conventional drugs. The median number of CPS per month decreased from 11.0 to 5.0 after addition of VGB, and 51% of patients had a 50% or greater decrease in CPS frequency (p less than 0.001). Side effects (principally drowsiness, ataxia, and headache) occurred mainly during the initiation of therapy and decreased during therapy. After 12 weeks on VGB, side effects significantly interfered with functioning in only 13% of patients, and the efficacy:toxicity ratio warranted continued administration in 74% of patients. Coadministration of VGB resulted in a mean decrease of 20% in phenytoin serum concentration (p less than 0.001). Sixty-six patients with a favorable response to VGB during the single-blind study have been followed for a median of 16.7 months on VGB. No serious systemic or neurologic toxicity has been detected, and most patients have retained their initial favorable CPS control.

Aminocaproates↗