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Biomedical subjects

M Harmer

Publications and source records attributed to M Harmer.

At least 37 records · Page 2Linked to original sources
PubMed2000

Evaluation of the use of the Flexiblade.

The Flexiblade is a laryngoscope which has a 'flexible' blade. The 'front' half of the blade can be moved in an anterior direction during laryngoscopy, enhancing the view of the glottis. The degree of movement can be controlled with the lever. We studied 200 ASA 1 and 2 adult patients requiring tracheal intubation and the patients acted as their own controls. The view of the larynx was improved in 93% of the cases when the vocal cords were not completely visible at laryngoscopy with the lever in the neutral position. Ninety-seven per cent of patients with a Cormack and Lehane grading of 2 at normal laryngoscopy were transformed to grade 1 when the lever of the Flexiblade was depressed and 84% of cases with a grading of 3 were transformed to grade 2 or 1. In four patients, there was deterioration in the view of the cords: three patients with grade 1 were transformed to grade 2 and one with grade 2 to grade 3. There was no improvement in one case with grade 2 and three with grade 3.

Adult↗
PubMed2000

Serum S100 protein as a marker of cerebral damage during cardiac surgery.

The identification of a serum marker to assist in the diagnosis of cerebral injury after cardiac surgery is potentially useful. S100 protein is an early marker of cerebral damage. It is released after cardiac surgery performed under cardiopulmonary bypass (CPB). Its level is correlated with the duration of CPB, deep circulatory arrest and aortic cross-clamping. Increased levels of S100 protein are correlated with the age of the patient and the number of microemboli, especially during aortic cannulation. Perioperative cerebral complications such as stroke, delayed awakening and confusion are associated with increased levels of S100 protein directly after bypass and from 15 to 48 h after it. In addition, increased levels of S100 protein are related to neuropsychological dysfunction after cardiac surgery. S100 protein has early and late release patterns after CPB; the early pattern may be due to sub-clinical brain injury. The late release pattern may be due to perioperative cerebral complications. Patients undergoing intracardiac operations combined with coronary artery bypass surgery are more susceptible to brain injury and have higher levels of S100 after CPB. Furthermore, adults and children undergoing deep circulatory arrest are more susceptible to brain injury, in terms of higher S100 protein release after CPB. Serum S100 protein levels are reduced after using arterial line filtration and covalent-bonded heparin to coat the inner surface of the CPB circuit.

Biomarkers↗
PubMed1999

A multicentre comparison of the costs of anaesthesia with sevoflurane or propofol.

Day-case anaesthesia requires rapidly eliminated anaesthetics which are relatively expensive. This multinational, multicentre European study assessed the relative costs of propofol or sevoflurane anaesthesia in 211 patients. Anaesthesia was induced and maintained with propofol in group 1, with propofol and sevoflurane in group 2, and with sevoflurane in group 3. Drug and delivery costs were calculated in US$. Induction of anaesthesia was fastest in groups 1 and 2, although spontaneous ventilation resumed earliest in group 3. Emergence times and times at which patients were fit for discharge were similar in all groups. Group 2 had the lowest costs based on actual drug use (mean $14.2 (SEM 0.8) vs $18.7 (0.8) and $17.3 (0.8) in groups 1 and 3, respectively). Anaesthetic drug wastage and disposable costs were highest in group 1 and lowest in group 3. Consequently, total costs were highest in group 1 ($31.9 (0.9)) compared with groups 2 ($19.7 (0.9)) and 3 ($18.8 (0.9)). Although we observed increased nausea and vomiting in groups 2 and 3 and reduced patient satisfaction in group 3, these differences should be balanced against the greater cost of propofol anaesthesia.

Adolescent↗
PubMed1998

A new gas jet method for the assessment of sensory block after spinal anaesthesia.

We evaluated a new method of assessing sensory block after spinal anaesthesia using a fine gas jet and compared it with other established methods. The gas jet method was used to test the block before and after surgery and was found to compare favourably with pin-prick (median difference 0 and 0 dermatomes) and ethyl chloride (median difference 0.5 and 1.0 dermatomes) but less well with cotton wool (median difference -2.0 and -2.0 dermatomes).

Anesthesia, Obstetrical↗
PubMed1998

A change in resistance? A survey of epidural practice amongst obstetric anaesthetists.

Five hundred members of the Obstetric Anaesthetists Association were surveyed regarding their technique for identification of the epidural space. Eighty-one per cent of the questionnaires were returned completed. Fifty-nine per cent of respondents first learned a loss of resistance to air technique, 33.4% to saline and 7.4% another technique. Presently, 37.1% and 52.7% use only a loss of resistance to air or saline, respectively. Six per cent use both techniques and 3.2% use other techniques. Twenty-eight per cent taught a loss of resistance to air, 57.2% taught a loss of resistance to saline and 12.9% taught both techniques. Twenty-three per cent changed from a loss of resistance to air, to a saline technique, and 4.2% vice versa. Forty-seven per cent of those using air felt that loss of resistance to air was not associated with a clinically significant difference in the incidence of accidental dural puncture compared with saline.

Air↗
PubMed1998

The effect of education, assessment and a standardised prescription on postoperative pain management. The value of clinical audit in the establishment of acute pain services.

A study involving 2738 patients in 15 hospitals in the United Kingdom was undertaken to evaluate the effect of simple methods of pain assessment and management on postoperative pain. The study consisted of four parts: a survey of current practice in each hospital; a programme of education for staff and patients regarding pain and its management; the introduction of formal assessment and recording of pain and the use of a simple algorithm to allow more flexible, yet safe, provision of intermittent intramuscular opioid analgesia; and a repeat survey of practice. One hospital from each of the former health regions of England and Wales was selected for inclusion in the project. Hospitals included representatives of different size units (university, large and small district general hospitals). As a result of the study, there was an overall reduction in the percentage of patients who experienced moderate to severe pain at rest from 32% to 12%. The incidence of severe pain on movement decreased from 37% to 13% and moderate to severe pain on deep inspiration from 41% to 22%. Similar decreases were seen in the incidence of nausea and vomiting. There was also a slight reduction in the incidence of postoperative complications. This study shows that simple techniques for the management of postoperative pain are effective in reducing the incidence of pain both at rest and during movement and should form part of any acute pain management strategy.

Analgesics, Opioid↗
PubMed1997

Comparison between halothane and sevoflurane for adult vital capacity induction.

We have examined the differences in ventilatory characteristics between halothane and sevoflurane when used for adult vital capacity induction of anaesthesia. The study was conducted in a randomized, double-blind manner. After 13 patients had been enrolled, the study was curtailed because the blinded observer thought that there was an unacceptably high incidence of adverse events. After the randomization code was revealed, the adverse events were found to be in the halothane group. Although the sample size was small, minute volumes appeared to be maintained in the sevoflurane group. Ventilatory frequencies were similar in the two groups after insertion of the laryngeal mask airway, but tidal volumes were significantly greater in the sevoflurane group (P = 0.0013).

Adolescent↗
PubMed1997

Environmental monitoring during gaseous induction with sevoflurane.

Recent research has shown that gaseous induction in adults with sevoflurane is an acceptable technique. This study was undertaken to assess if gaseous induction using sevoflurane carried in both oxygen alone, and in nitrous oxide and oxygen combined, would provide acceptable pollution levels. As an occupational exposure standard has not been set for sevoflurane, we used the target level of 20 ppm set by the manufacturer. Environmental monitoring was carried out in the anaesthetic room during eight lists where consecutive triple vital capacity sevoflurane inductions were performed. Time-weighted averages for both gases over the duration of the lists were well below the occupational exposure standards (mean 1.1 (range 0.6-1.7) for sevoflurane and 17.3 (12-23) for nitrous oxide). There were high peak concentrations during the induction process (8.3 (4.1-17) for sevoflurane and 172.4 (65-310) for nitrous oxide) although these decreased to low concentrations between anaesthetic inductions. Personal sampling was carried out from the anaesthetist's breathing zone and concentrations were also low (1.2 (0.8-2.1) for sevoflurane and 45.9 (10.1-261.6) for nitrous oxide.

Adult↗
PubMed1997

Single-breath inhalation induction of sevoflurane anaesthesia with and without nitrous oxide: a feasibility study in adults and comparison with an intravenous bolus of propofol.

The induction characteristics of sevoflurane in nitrous oxide and oxygen were compared with sevoflurane in oxygen alone and a propofol infusion. A vital capacity technique was used for the gaseous induction groups using a Mapleson A system and a 4-litre reservoir bag. Four end-points of anaesthesia were recorded: time to cessation of finger tapping, time to loss of eyelash reflex, time to jaw relaxation and time to regular settled breathing after laryngeal mask airway insertion. We also recorded sequential blood pressure and pulse rate, the incidence of adverse airway events and the acceptability of the induction technique. Propofol had a faster time to cessation of finger tapping (p < 0.05) and jaw relaxation (p < 0.01). These differences disappeared with the final induction stage and sevoflurane in nitrous oxide and oxygen had the faster time to regular settled breathing, though this did not reach statistical significance. Cardiovascular stability was good and comparable in all groups. There were few adverse airway events in any group and none caused oxygen saturation to fall below 96%. There was more excitation in the gaseous induction groups, though this did not interfere with induction. Patient satisfaction with induction was high.

Adolescent↗
PubMed1996

A comparison of opioid solutions for patient-controlled epidural analgesia.

Sixty patients took part in a randomised, double-blind study to compare the analgesic and side effects of three opioid-containing solutions for patient-controlled epidural analgesia following abdominal surgery. Patients in group 1 received a solution containing bupivacaine 0.125% with fentanyl 10 micrograms.ml-1, group 2 bupivacaine 0.125% with diamorphine 125 micrograms.ml-1, group 3 pethidine 2.5 mg.ml-1. All groups received 4 ml.h-1 background infusion and 3 ml boluses every 20 min if necessary. There were no significant differences between the groups in visual analogue scale pain scores (p = 0.537) or volumes of solution used at 24 h (p = 0.351) or 48 h (p = 0.105). Motor block was significantly higher in group 2 (p < 0.004) and pruritus occurred significantly less in group 3 (p < 0.05). We conclude that these three solutions produce equivalent analgesia but that pethidine 2.5 mg.ml-1 may be associated with fewer side effects.

Aged↗