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Biomedical subjects

Neil Roy Connelly

Publications and source records attributed to Neil Roy Connelly.

18 recordsLinked to original sources
PubMed2005

Unusual positioning of a central venous catheter.

Central venous cannulation, with or without a flow-directed pulmonary artery catheter, is commonly performed in patients undergoing cardiac surgery to measure central filling pressure and cardiac output, and to administer medications and fluids. The complications of central venous cannulation are numerous and include malposition, arterial puncture, pneumothorax, hemothorax, chylothorax, extravasation of infusate, thrombophlebitis, and infection. We describe a single-lumen catheter that was placed through the hemostatic valve of a 9F percutaneous introducer, which inadvertently entered the left internal mammary (internal thoracic) vein. The current case is unique in that it was diagnosed by visualization of the catheter during surgical dissection.

Aged↗
PubMed2004

Resident training in advanced airway management.

Management of the difficult airway is an essential skill that should be taught during an anesthesiology residency. However, only a minority of anesthesiology residency programs have formal rotations in advanced airway management. We developed a formal advanced airway rotation as an integral part of our residency program, consisting of two 1-month rotations during the residency, each with a separate focus. While on the advanced airway rotation, the resident anesthesiologist is given a set of objectives, a list of required reading, and a required number of procedures unique to advanced airway management that they must perform during the rotation. We believe that this rotation has been beneficial in improving the residents' exposure to advanced airway techniques, and has dramatically improved their capabilities in this important aspect of anesthetic of anesthetic training. Additionally, the structure of the rotation ensures uniformity in the residents' acquisition of advanced airway skills.

Anesthesiology↗
PubMed2004

Analgesic effect of clonidine added to bupivacaine 0.125% in paediatric caudal blockade.

BACKGROUND: Caudals are a common method of providing pain relief in children undergoing surgery. Clonidine, an alpha(2) agonist, exhibits significant analgesic properties. The current investigation sought to determine whether caudal clonidine added to caudal bupivacaine would decrease pain in paediatric patients undergoing surgery. METHODS: Thirty-six children undergoing elective surgery were studied. Following anaesthetic induction, a caudal was placed (1 mg.kg(-1) bupivacaine 0.125%) with an equal volume of either clonidine (2 microg.kg(-1)) or saline. Perioperative analgesic requirements in the postanaesthesia care unit (PACU) and at home following hospital discharge, and parental pain scores were evaluated. RESULTS: There were no significant demographic, haemodynamic, or pain score differences between the groups. There was no difference in analgesic duration between groups. There were significantly more children who vomited during the first 24 postoperative hours in the clonidine group than in the saline group (eight in clonidine, two in saline; P < 0.05). CONCLUSION: We do not recommend adding clonidine (2 microg.kg(-1)) to a bupivacaine (0.125%) caudal block in children undergoing surgery.

Adrenergic alpha-Agonists↗
PubMed2004

Early intravenous cannulation in children during sevoflurane induction.

BACKGROUND: It has been shown that early placement of an intravenous line in children anesthetized with halothane is equally safe compared with later placement. Whether this is true of sevoflurane is not known. METHODS: Pediatric patients, age 1-18 years, undergoing elective general anesthesia via an inhalation induction were randomized to intravenous placement either 30 or 120 s following loss of lid reflex. Movement on intravenous placement and incidence of laryngospasm were determined. Difficulty with intravenous placement was recorded. RESULTS: Movement on intravenous placement was more prevalent in the early group than in the late group (P < 0.0001). There was no laryngospasm in the late group and eight cases in the early group (P < 0.004). Children who had laryngospasm were older (P < 0.02) and weighed more (P < 0.04). Older children in the early group were more likely to have significant movement. CONCLUSION: Following an inhalation induction with sevoflurane in children, movement with intravenous placement was greater, and the incidence of laryngospasm was higher, when the intravenous access was attempted 30 s rather than 120 s following loss of lid reflex. We recommend waiting two min following the loss of lid reflex before attempting intravenous placement in children receiving an inhalation induction with sevoflurane.

Adolescent↗
PubMed2003

Survey of anesthesia practice in spine surgery patients in the United States.

PURPOSE: There is a wide range of anesthetic practice in spine surgery with respect to anesthetic choice, blood conservation, and monitoring. There is no ideal technique with respect to each of these choices. This study was designed to determine the usual practice for members of the Society of Neurosurgical Anesthesia and Critical Care (SNACC), with regard to the use of anesthetic technique, the type of monitoring used (and the person responsible for its application and interpretation), and the blood conservation strategies most often utilized for the management of patients undergoing spinal surgery. METHODS: A total of 415 questionnaires were mailed to all current members of the SNACC. Of these, 85 (23%) were completed and returned. RESULTS: The majority of the respondents administer general anesthesia for lumbar laminectomy. Somatosensory evoked potential (SSEP) monitoring is available at most of the institutions (94%) but only utilized in 75% of patients undergoing a Harrington rod placement. Motor evoked potential monitoring is available at 50% of the institutions, but utilized 25% of the time for these surgeries. The two most frequent blood conservation strategies utilized are intraoperative salvage and autologous donation. CONCLUSION: The most frequent monitoring utilized for major spinal surgeries is SSEP. Autologous donation and intraoperative salvage are the most frequent blood conservation methods utilized.

Anesthesia↗
PubMed2003

Teaching with a video system improves the training period but not subsequent success of tracheal intubation with the Bullard laryngoscope.

BACKGROUND: The Bullard laryngoscope is useful for the management of a variety of airway management scenarios. Without the aid of a video system, teaching laryngoscopy skills occurs with indirect feedback to the instructor. The purpose of this study was to determine if use of a video system would speed the process of learning the Bullard laryngoscope or improve the performance (speed or success) of its use. METHODS: Thirty-six anesthesia providers with no previous Bullard laryngoscope experience were randomly divided into two groups: initial training (first 15 intubations) with looking directly through the eyepiece (n = 20), or with the display of the scope on a video monitor (n = 16). The subjects each then performed 15 Bullard intubations by looking directly through the eyepiece. RESULTS: There was not an overall significant difference in laryngoscopy or intubation times between the groups. When only the first 15 intubations were considered, the laryngoscopy time was shorter in the video group (26 +/- 24) than in the nonvideo group (32 +/- 34; P< 0.04). In the first 15 patients, there were fewer single attempts at intubation (67.9% vs 80.3%; P< 0.002) and more failed intubations (17.2% vs 6.0%; P< 0.0001) in the nonvideo group. CONCLUSIONS: In conclusion, the authors have shown that use of a video camera decreases time for laryngoscopic view and improves success rate when the Bullard laryngoscope is first being taught to experienced clinicians. However, these benefits are not evident as more experience with the Bullard laryngoscope is achieved, such that no difference in skill with the Bullard laryngoscope is discernible after 15 intubations whether a video system was used to teach this technique.

Female↗
PubMed2003

Diluent volume for epidural fentanyl and its effect on analgesia in early labor.

UNLABELLED: Epidural fentanyl after a lidocaine and epinephrine test dose provides adequate analgesia and allows for ambulation during early labor. We designed the current study to determine the influence of the diluent volume of the epidural fentanyl bolus (e.g., whether it has an effect on the onset and duration of analgesia). Sixty laboring primigravid women received a 3-mL epidural test dose of lidocaine with epinephrine and then received a fentanyl 100- micro g bolus in either a 2-mL, 10-mL, or 20-mL volume. Pain scores and side effects were recorded for each patient. The onset of analgesia was similar in all three groups. The mean duration before re-dose was not significantly different in the 2-mL group (108 +/- 40 min), the 10-mL group (126 +/- 57 min), or the 20-mL group (126 +/- 41 min). No patient in any group experienced any detectable motor block; one patient (2-mL group) complained of mild knee weakness and was not allowed to ambulate. In early laboring patients, the volume in which 100 micro g of epidural fentanyl (after a lidocaine-epinephrine test dose) is administered does not affect the onset or duration of analgesia, nor does it affect the ability to ambulate. IMPLICATIONS: In early laboring patients, the volume in which 100 micro g of epidural fentanyl (after a lidocaine-epinephrine test dose) is administered does not affect the onset or duration of ambulatory analgesia.

Adult↗
PubMed2003

Gastrointestinal symptoms secondary to implanted spinal cord stimulators.

IMPLICATIONS: We report severe gastrointestinal symptoms in two patients who had implanted spinal cord stimulators. These side effects were severe enough to require cessation of the stimulation, even though the patients reported significantly improved analgesia. It is important for clinicians caring for patients with these devices to be aware of these potentially severe side effects.

Adult↗
PubMed2003

An evaluation of the safety and efficacy of administering rofecoxib for postoperative pain management.

UNLABELLED: The goal of our study was to evaluate the analgesic efficacy and safety of administering rofecoxib (1 mg/kg), a cyclo-oxygenase (COX)-2 selective nonsteroidal antiinflammatory drug, before pediatric tonsillectomy. Sixty-six patients, aged 3-11 yr, scheduled to undergo tonsillectomy received either placebo or rofecoxib (1 mg/kg). There were no significant differences between the two study groups with respect to demographics and blood loss. We found that the pain scores were significantly lower in the rofecoxib group compared with the control group at 2 h (P < 0.05) and 24 h (P < 0.006). The incidence of nausea (P < 0.03) and vomiting (P < 0.004) at home was more frequent in the control group than in the rofecoxib group. We conclude that a single preoperative dose of rofecoxib resulted in less vomiting and lower 24-h pain scores in pediatric patients undergoing an elective tonsillectomy. IMPLICATIONS: In children undergoing tonsillectomy, a single preoperative dose of rofecoxib decreases 2- and 24-h pain and decreases nausea and vomiting at home.

Acetaminophen↗
PubMed2003

Hyperkalemia and pyloric stenosis.

UNLABELLED: Children presenting with pyloric stenosis have hypochloremic metabolic alkalosis and their serum potassium levels are thought to be low or normal. We reviewed potassium levels in infants with pyloric stenosis. Thirty-six percent of patients with pyloric stenosis had increased serum potassium levels. We conclude that hyperkalemia may be more common in children with pyloric stenosis than previously thought. IMPLICATIONS: A significant number of infants with pyloric stenosis have a serum potassium value above the normal limit.

Anesthesia↗
PubMed2002

Analgesia for paediatric tonsillectomy and adenoidectomy with intramuscular clonidine.

BACKGROUND: After undergoing tonsillectomy and adenoidectomy (T&A), children may experience significant pain. Clonidine, an alpha2 agonist, exhibits significant analgesic properties. The current investigation sought to determine whether intramuscular (I.M.) clonidine would decrease pain in paediatric patients undergoing T&A. METHODS: Thirty-nine children undergoing elective T&A were studied. Following inhalational anaesthetic induction, fentanyl (2 microg x kg(-1)) was given intravenously, acetaminophen (paracetamol) (30 mg.kg-1) was given rectally and the children then randomly received an i.m. injection of either normal saline or clonidine (2 microg x kg(-1)). Perioperative analgesic requirements in the postanaesthesia care unit and at home following hospital discharge were evaluated. RESULTS: There were no significant demographic, analgesic consumption, haemodynamic or pain score differences between the groups. CONCLUSIONS: We do not recommend adding i.m. clonidine (2 microg x kg(-1)) to the analgesic regimen of children undergoing tonsillectomy and adenoidectomy.

Acetaminophen↗
PubMedDate not supplied

The addition of hydromorphone to epidural fentanyl does not affect analgesia in early labour.

PURPOSE: Epidural fentanyl after a lidocaine and epinephrine test dose, provides adequate analgesia and allows for ambulation during early labour. The current study was designed to determine the influence of hydromorphone added to an epidural fentanyl bolus (e.g., whether there is an increase in duration of analgesia). METHODS: Forty-four labouring primigravid women, at less than 5 cm cervical dilation, who requested epidural analgesia were enrolled in this randomized, double-blind study. After a 3 mL test dose of lidocaine with epinephrine, patients received fentanyl 100 microgram (in 10 mL volume). They randomly received the fentanyl with either saline or hydromorphone (300 microgram). After administration of the initial analgesic, pain scores and side effects were recorded for each patient at ten, 20, and 30 min, and every 30 min thereafter, by an observer blinded to the technique used. RESULTS: The patients were taller in the hydromorphone group (P < 0.04). There were no other demographic differences between the two groups. The mean duration prior to re-dose was not significantly different in the group that received hydromorphone (135 +/- 52 min) compared to the control group (145 +/- 46 min). Side effects were similar between the two groups. No patient in either group experienced any detectable motor block. CONCLUSION: In early labouring patients, the addition of hydromorphone (300 microgram) to epidural fentanyl (100 microgram after a lidocaine and epinephrine test dose) neither prolongs the duration of analgesia nor affects the ability to ambulate, and cannot be recommended according to the current study.

Adult↗