Biomedical subjects
P R Bromage
Publications and source records attributed to P R Bromage.
Prolongation of postoperative epidural sufentanil analgesia with epinephrine.
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Epidural analgesia and neonatal hyperbilirubinemia.
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Extradural analgesia revisited.
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Currentness of textbook references alone not a valid measure of quality.
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Peridurography with metrizamide: animal and human studies.
Metrizamide (300 mg l/ml) was tested for spinal peridurography in conscious dogs and humans. Epidural metrizamide was non-irritating in volumes up to 12 ml. Larger volumes caused mild discomfort in two patients. Radiographic contrast was satisfactory, and there were no sequelae. Peridurography with metrizamide (300 mg l/ml) appears to be a safe, useful diagnostic procedure in ambulant patients.
'Paraplegia following epidural analgesia': a misnomer.
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Letter: Obesity: its relation to anaesthesia.
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Letter: Death in outpatient dental practice. Deaths following local analgesia: possible pontine anaesthesia.
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Mechanism of action of extradural analgesia.
The factors governing the spread and site of action of local anaesthetics in the extradural space are discussed. Local anaesthetic drugs injected into the extradural space may cause nerve blocks at three possible sites: (a) On the spinal nerves in the paravertebral space. This probably occurs only in young subjects. (b) On the spinal nerves intradurally. This is probably the essential site of blockade. (c) On the spinal cord.
Magnetic resonance imaging implications of metal-reinforced spinal microcatheters.
STUDY OBJECTIVE: To estimate the magnitude behavior of ferrous-alloy, wire-reinforced microcatheters for subarachnoid anesthesia and the possible hazards of exposing patients to magnetic resonance imaging (MRI) after accidental catheter fracture within the subarachnoid space. DESIGN: Open, qualitative in vitro study. SETTING: MRI facility of a university-affiliated medical center. MEASUREMENTS AND MAIN RESULTS: Measurements were made of the angular deflection of 28-gauge and 32-gauge TFX catheters from their resting alignment by a small bar magnet. Mobility of 28-gauge catheter fragments 3.0 to 3.5 cm in length and 3.3 to 4.0 mg in mass were tested (1) when lying free on a polished surface in an MRI magnetic field of 1.5 tesla and 60 cm from the magnetic casing, and (2) when mounted on a mildly viscous agar surface 40 to 50 cm from the magnetic casing. Catheters were attracted to a small bar magnet and could be pulled out of alignment by the magnetic attraction to a degree inversely proportional to their caliber. Catheter fragments released in a magnetic field of 1.5 tesla flew from a glass surface and attached themselves firmly to the magnet casing, while catheter fragments adhering to an agar surface were not levitated but were rotated from their resting orientation. CONCLUSIONS: The microcatheters under test exhibited marked magnetic properties. Two questions arise: First, should MRI be avoided in patients where broken TFX catheter fragments may lie partly or completely within the subarachnoid space? Second, should ferrous metallic strengthening wire be replaced by a nonmetallic fiber of comparable or greater tensile strength? Further in vitro studies are indicated to answer these questions.
Venous air embolism during cesarean delivery.
Recent reports have indicated that subclinical venous air embolism (VAE) may occur in 50-65% of patients during cesarean delivery, with a potential for life-threatening embolic events. We attempted to confirm this incidence using precordial Doppler monitoring and to examine the occurrence of correlative signs thought to accompany embolic events. Doppler changes, oxygen saturation (SaO2), and ECG were monitored in 63 patients during cesarean delivery; 60 received regional anesthesia, and three, general anesthesia. Six of 63 (10%) had Doppler changes consistent with VAE. Nineteen patients (30%) had small decreases in SaO; most of these were not associated with Doppler changes or any other finding. Two patients had transient S-T segment depression. Fourteen of the 60 patients receiving regional anesthesia (23%) reported chest pain or discomfort at some point during the procedure. This incidence of Doppler changes was significantly smaller than previously reported and was not significantly correlated with other signs reported to accompany VAE. Positive signs of VAE were more frequent when the uterus was exteriorized than when it was maintained within the abdomen during surgical repair.