Biomedical subjects
P R Howell
Publications and source records attributed to P R Howell.
Clinical governance--what's it all about?
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Physostigmine: going ... going ... gone? Two cases of central anticholinergic syndrome following anaesthesia and its treatment with physostigmine.
Two patients presented with very different signs of central anticholinergic syndrome following general anaesthesia for which they had received premedication with hyoscine. Both responded dramatically to 1 mg of intravenous (i.v.) physostigmine, which produced a rapid return to a normal level of consciousness. The aetiology of central anticholinergic syndrome is multi-factorial, but the diagnosis should be considered in all patients who demonstrate abnormal post-anaesthetic awakening. It is recommended that 1 mg of intravenous physostigmine is a safe and effective treatment for central anticholinergic syndrome, and that a supply of this important drug must be kept readily available in the recovery area of the operating theatre department.
Patient-controlled analgesia following caesarean section under general anaesthesia: a comparison of fentanyl with morphine.
This prospective, randomised, double-blind study compared PCA fentanyl with PCA morphine for post-Caesarean section analgesia. Following a standardised general anaesthetic, 37 women were allocated to receive either fentanyl (n = 18) or morphine (n = 19). The PCA was commenced after the women had been made comfortable in the postanaesthetic recovery room with the appropriate opioid solution (mean dose required = fentanyl 375 micrograms or morphine 16 mg). Initial PCA settings were bolus 1 ml (fentanyl 25 micrograms or morphine 1 mg), lockout time ten minutes, and no background infusion. Both analgesic solutions provided effective analgesia for a mean of 37 hr with high levels of patient satisfaction, and there were no differences in VAS scores for pain and patient satisfaction, or for side effects (nausea, itch, and sleepiness) between fentanyl or morphine. However, more patients in the fentanyl group required supplementary boluses or alterations to the PCA settings (13/18 vs 4/19: P = 0.005), and one patient was removed from the study due to inadequate analgesia. We conclude that fentanyl is not recommended for routine PCA use following Caesarean section.
Comparison of two fentanyl doses to improve epidural anaesthesia with 0.5% bupivacaine for caesarean section.
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Lupus anticoagulant, paramyotonia congenita and pregnancy.
A case report is presented of the anaesthetic management of a parturient with paramyotonia congenita and lupus anticoagulant antibodies. She had been treated with prophylactic, subcutaneous heparin and aspirin throughout her pregnancy. Epidural analgesia was provided for labour and delivery.
Meningioma misdiagnosed as senile dementia.
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An experience of war surgery and wounds presenting after 3 days on the border of Afghanistan.
The International Committee of the Red Cross (ICRC) has run hospitals for the wounded of the conflict in Afghanistan since 1981. For political and geographical reasons the hospitals are situated in Pakistan, some distance from the fighting, and so the wounded may take many days to arrive. This has enabled a surgical team provided by the British Red Cross Society to observe wounds of varying age and degrees of putrefaction or healing. Twenty-nine (29) patients with wounds of 3 or more days are detailed. The old wounds showed a tendency either to putrefaction or healing and the surgical management had to be revised accordingly. Wounds sutured in the field tended to putrefy. Among the various problems, the most taxing and difficult were the cultural and religious objections to amputation. The ICRC is committed to providing surgical hospitals for the Afghan war wounded for as long as the conflict lasts. It has adapted the local facilities and staff to the particular political, geographical and cultural situation.