Search PubMed⌕ Search

Biomedical subjects

M Harmer

Publications and source records attributed to M Harmer.

At least 55 records · Page 3Linked to original sources
PubMed1994

Back to basics?

Explore the source record for details and available documents.

Anesthesiology↗
PubMed1993

Nausea and vomiting after gynaecological surgery: a meta-analysis of factors affecting their incidence.

A total of 1442 patients who had major gynaecological surgery were recruited into three multicentre studies using a standard general anaesthetic technique in order to assess the efficacy of various doses of orally administered ondansetron in the prevention of postoperative nausea and vomiting. A total of 1257 patients were included in this analysis: 420 received oral formulations of placebo and 212, 296 and 329 received ondansetron 1, 8 and 16 mg, respectively. The following factors were measured in these studies and were considered to have a possible influence on the proportion of patients experiencing postoperative nausea and vomiting: age of patient; volatile anaesthetic; intraoperative dose of fentanyl; postoperative dose of morphine; country; anaesthesia duration; neuromuscular blocker; neuromuscular block antagonist; premedicant; recovery time; type of surgery; antiemetic treatment; body weight. Using a process of elimination based on logistic regression techniques, the factors found to be the most important influences on the frequencies of nausea and vomiting were antiemetic treatment, type of surgery, neuromuscular blocker, country, volatile anaesthetic and age. A statistically significant interaction between type of surgery and age was observed. Adjusted probabilities of nausea and vomiting were obtained from the model, including all the above factors, together with the type of surgery by age interaction. Ondansetron 8 mg showed the smallest adjusted probability of nausea (0.54) and vomiting (0.34) and placebo the greatest (nausea 0.75, vomiting 0.61). A similar pattern of adjusted probabilities over neuromuscular blocking agents was seen for nausea and vomiting, with the greatest occurring in patients receiving pancuronium (nausea 0.74, vomiting 0.57) and the least in patients receiving alcuronium (nausea 0.59, vomiting 0.38).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

A comparison between mivacurium and suxamethonium in children.

The neuromuscular effects of mivacurium were compared with those of suxamethonium in 69 children (aged 2-12 years), during nitrous oxide, oxygen and halothane anaesthesia in a randomised open study. Neuromuscular block was monitored by measuring the acceleration of the thumb caused by contraction of the adductor pollicis muscle after supramaximal stimulation of the ulnar nerve at the wrist using an Accelograph. End-tidal carbon dioxide was maintained at about 4 kPa in both groups. The mean times (95% confidence intervals) for T1:T0 ratio to decrease to 75%, 50%, 25% and 5% of control values were 50 (42-59), 62 (52-74), 83 (68-100) and 93 (46-108) s respectively for mivacurium and 18 (15-22), 26 (22-30), 32 (28-37) and 43 (38-49) s respectively for suxamethonium. The times for T1:T0 ratio to recover to 25%, 50% and 70% of control values were 615 (542-698), 769 (687-859) and 901 (820-993) s respectively for mivacurium and 196 (179-214), 216 (201-234) and 242 (216-259) s respectively for suxamethonium. The range of maximum block was similar for both drugs. The average time to reach maximum block was 143 s for mivacurium and 56 s for suxamethonium. Intubating conditions were similar in the two groups.

Child↗
PubMed1992

Policy for controlling pain after surgery: effect of sequential changes in management.

OBJECTIVE: To observe the effects of introducing an acute pain service to the general surgical wards of a large teaching hospital. DESIGN: A study in seven stages: (1) an audit of current hospital practice succeeded by the sequential introduction to the general surgical wards of (2) pain assessment charts; (3) an algorithm to allow more frequent use of intramuscular analgesia; (4) increased use of local anaesthetic techniques of wound infiltration and nerve blocks; (5) an information sheet for patients about postoperative pain; (6) the introduction of patient controlled analgesia; (7) a repeat audit of hospital practice. Data were collected on each patient 24 hours after operation. SETTING: University Hospital of Wales, which has both district general and tertiary referral functions. PATIENTS: 2035 patients over nine months from all surgical specialties (excluding cardiac) at the hospital. General surgical operations were studied in detail and separated into major, intermediate, and minor for data collection. MAIN OUTCOME MEASURES: A change in the median visual analogue pain scores 24 hours after surgery for pain during relaxation, pain on movement, and pain on deep inspiration at each stage of the study. RESULTS: There was a reduction in median visual analogue scores during the study. The median (95% confidence interval) scores for pain during relaxation decreased from 45 (34 to 53) in stage 1 to 16 (10 to 20) in stage 7 for major surgical procedures. Pain on movement decreased from 78 (66 to 80) to 46 (38 to 48), and pain on deep inspiration decreased from 64 (48 to 78) to 36 (31 to 38). The reductions in median scores for intermediate and minor operative procedures showed similar patterns. CONCLUSIONS: The introduction of an acute pain service to the general surgical wards led to considerable improvement in the level of postoperative pain as assessed by visual analogue scores. Simple techniques of regular pain assessment and the more frequent use of intramuscular analgesia as a result of using an algorithm were particularly effective.

Algorithms↗
PubMed1992

Epidural pethidine and bupivacaine in labour.

A double-blind randomised study was performed to assess the value of the addition of pethidine 50 mg to the initial dose of bupivacaine given for epidural analgesia in labour. Forty-nine patients received either 1 ml of saline (n = 24), or 50 mg of pethidine (n = 25), added to 9 ml of 0.25% bupivacaine as an initial injection for intrapartum epidural analgesia. There was a significant increase in the mean duration of analgesia in the pethidine group. However, pethidine did not increase the speed of onset of analgesia, or improve the quality of analgesia.

Adult↗
PubMed1991

Spondyloepiphyseal dysplasia congenita. Caesarean section under epidural anaesthesia.

Spondyloepiphyseal dysplasia congenita is a rare condition with several features of concern to the anaesthetist. The patients are of extremely short stature and the presence of kyphoscoliosis may lead to significant respiratory impairment. Cervical vertebral body changes can result in spinal cord compression and laryngotracheal stenosis may be present. The management of such a patient presenting for elective Caesarean section under epidural anaesthesia is described.

Adult↗
PubMed1990

Isoflurane with either 100% oxygen or 50% nitrous oxide in oxygen for caesarean section.

Two hundred mothers undergoing general anaesthesia for Caesarean section were allocated randomly to receive either 100% oxygen (group 100) or 50% nitrous oxide in oxygen (group 50), both supplemented with isoflurane. In each group the concentrations of isoflurane were chosen to deliver 1.5 MAC for the first 5 min after induction and 1.0 MAC thereafter. The mean umbilical venous PO2 was greater in group 100 for emergency sections (P = 0.001). Babies born to mothers in group 100 required less resuscitation than those in group 50 (P = 0.04) and there was a tendency to higher Apgar scores at 1 min in group 100, although this was not statistically significant. There were no instances of awareness, although two patients in group 100 and three in group 50 reported dreaming. This study confirms earlier findings that the use of 100% oxygen can significantly improve fetal oxygenation during Caesarean section, with particular benefit in emergency cases. This is associated with a lower incidence of neonatal resuscitation.

Anesthesia, General↗
PubMed1983

Intramuscular on demand analgesia: double blind controlled trial of pethidine, buprenorphine, morphine, and meptazinol.

An on demand intramuscular analgesic system using the Cardiff Palliator was tested. Forty consenting patients were studied after cholecystectomy in a double blind trial using increments of buprenorphine (0.15 mg), meptazinol (50 mg), morphine (5 mg), and pethidine (50 mg). Most patients attained good levels of pain relief (mean analogue pain score 36.5), comparable to intravenous on demand analgesia. There were no technical complications. Significant differences were found between drugs in dizziness (pethidine produced the worst score) but not with other side effects. Buprenorphine produced longer lasting analgesia than meptazinol or pethidine and also gave the lowest pain scores. Patterns of analgesic consumption were the same as with intravenous on demand systems, but larger amounts of drug were generally used. Relative analgesic potencies derived from drug consumption rates were also consistent with those from intravenous on demand studies. An on demand intramuscular analgesic system offers a simple but effective means of relieving severe postoperative pain.

Adolescent↗
PubMed1983

Comparison between buprenorphine and pentazocine given i.v. on demand in the control of postoperative pain.

A double-blind comparison between buprenorphine and pentazocine was performed in 20 patients using an on demand analgesic system to provide analgesia after operation. The quality of analgesia, assessed subjectively, was good with both drugs and drug consumptions were compatible with previous potency estimates. The mean doses demanded in 24 h of buprenorphine (1.68 mg) and of pentazocine (382 mg) are consistent with those found in other trials although the between-patient variation was five- or six-fold. There was no significant difference in side-effects between the two groups. Buprenorphine and pentazocine may be used successfully in an on demand system to provide relief of severe pain after operation.

Adolescent↗