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Biomedical subjects

R L Holland

Publications and source records attributed to R L Holland.

At least 19 recordsLinked to original sources
PubMed2003

A prospective clinical audit of central venous catheter use and complications in 1000 consecutive patients.

We conducted a prospective audit of central venous catheter (CVC) use in 1000 consecutive patients to better define the rates of postoperative complications (particularly vascular perforation) and the pattern of CVC and pulmonary artery catheter (PAC) usage (particularly the number of lumens inserted and utilized). Details of CVCs, complications, and the number of lumens in place and used, were recorded daily until all CVCs were removed. A total of 1546 CVCs and 223 PACs were placed in study patients. Two non-fatal perforations occurred: a perforated right atrium in a patient who received an Arrow triple-lumen CVC (previously reported), and a perforated pulmonary artery in a patient upon withdrawal of a Baxter PAC. The risk per patient of any CVC-related perforation was 0.2% (95% confidence interval (CI): 0.02% to 0.7%). The rates of CVC-related sepsis and local infection were 3% (95% CI: 2% to 4%) and 2% (95% CI: 1% to 3%) respectively. At the peak of CVC use (day 1 in the ICU) the overall number of lumens placed was significantly correlated with lumens used (r = 0.53), endorsing clinical judgement in the anticipation of the needs of the patient. The modal number of lumen uses in adults and children was four. However, in children, fewer catheters were inserted per patient than in adults (1.28 vs 1.63, P = 0.01), and placed lumens were used more intensively (P < 0.001). Data appear to justify the routine selection of a triple-lumen CVC in adult patients, but not of a quad-lumen CVC.

Adolescent↗
PubMed1999

A prospective randomized clinical assessment of a new pigtail central venous catheter in comparison with standard alternatives.

The Cook Pigtail central venous catheter (CVC) has been designed to diminish the risk of vascular perforation and consequent cardiac tamponade. With the participation of 12 consultant anaesthetists and 19 registrars, adults undergoing elective surgery were randomized to receive either a Pigtail (n = 101) or their consultant anaesthetists' "standard" CVC (n = 102). Median ease of insertion was rated 8 for Pigtail CVCs and 9 for standards (10 being best; P = 0.001). Arrhythmias occurred during 16 standard and 33 Pigtail central venous catheter insertions (P < 0.006). No significant difference was found in insertion time or radiographically assessed tip depth for standard and Pigtail central venous catheters. A perforated right atrium of uncertain cause occurred in a patient who received an Arrow triple-lumen central venous catheter. Participating consultant anaesthetists preferred their "standard" central venous catheter for routine use, but five indicated that they would select a Cook Pigtail where long-term use was planned because of in vitro evidence of its greater safety.

Adolescent↗
PubMed1998

Central regional anaesthesia in a patient with Klippel-Trenaunay syndrome.

A 27-year-old female with Klippel-Trenaunay Syndrome presented for reconstructive surgery of the deep venous system of the right leg. Contrast enhanced dynamic computed tomography was performed to exclude the presence of arteriovenous malformation of the lumbosacral spine. A combined spinal-epidural technique supplemented with light general anaesthesia was performed. The patient's condition was stable throughout the three hours of surgery and postoperative analgesia was maintained successfully for three days.

Adult↗
PubMed1996

Anaesthesia information--what patients want to know.

We developed and introduced into clinical practice a leaflet to improve the delivery of information to patients before obtaining their consent to anaesthesia. The amount of information needs to be what a "reasonable" patient thinks appropriate; therefore we tested patients' responses to three levels of information: "full" disclosure, "standard" disclosure (as contained in our leaflet) and "minimal" disclosure. Forty-five patients scheduled to undergo cardiac surgery were enrolled in the study. None of the information sheets caused a significant change in state anxiety score and only the "full" disclosure significantly increased knowledge about anaesthesia (P = 0.016). All leaflets were easy to understand. When only one leaflet was provided 64-73% of patients thought the content was "just right", whereas when all three leaflets were viewed together, 63% of patients thought the "minimal" leaflet withheld too much information.

Analysis of Variance↗
PubMed1994

Single dose human pharmacology of umespirone.

We have compared the cognitive, EEG, and neuroendocrine effects of single doses of umespirone (20 mg and 80 mg) with those of buspirone (30 mg) and placebo in double-blind, cross-over studies in 44 healthy men. The pattern and time-course of the cognitive effects with umespirone and buspirone were dissimilar. Peak effects of buspirone were seen shortly after dosing and then receded, whilst the effects of umespirone persisted for up to 23 h. Although both drugs objectively impaired attention, buspirone reduced subjective alertness, calmness, and contentedness, whilst umespirone increased subjective alertness and contentedness and showed potential to improve secondary verbal memory. The EEG effects of umespirone were different from those seen with buspirone; they included a decrease of power in the alpha 1 band and the beta bands in the frontocentral area and an increase in the delta and theta bands in the occipitotemporal area. Umespirone had a later onset of action than buspirone but its effects lasted longer. Similar transient increases in serum prolactin and growth hormone concentrations were seen with buspirone and 80 mg umespirone; umespirone 20 mg had no effect. Plasma concentrations of ACTH and adrenaline and serum concentrations of cortisol were unaffected by either dose of umespirone. There was some evidence that buspirone increased ACTH and cortisol concentrations in some cases, and that umespirone increased noradrenaline concentrations. The frequency of adverse events was higher with buspirone than with 80 mg of umespirone. At the lower dose of umespirone, the frequency was similar to that with placebo.

Adult↗
PubMed1992

Fluvoxamine does not interact with alcohol or potentiate alcohol-related impairment of cognitive function.

OBJECTIVE: To assess whether fluvoxamine alters the pharmacokinetics of alcohol or potentiates alcohol-related impairment of cognitive function. METHODS: The study design required partially "blinded" balanced crossover studies, each involving 12 healthy male volunteers who each received a 40 gm dose of intravenous or oral alcohol after single and multiple doses of 50 mg fluvoxamine. Main outcome measures for pharmacokinetics were venous blood alcohol and plasma fluvoxamine. Main outcome measures for pharmacodynamics were word recall, simple and choice reaction time, number vigilance, memory scanning, and word recognition. RESULTS: The pharmacokinetics of intravenous alcohol were not affected by concomitant administration of fluvoxamine. Compared with placebo-alcohol, alcohol slightly increased the rate of fluvoxamine absorption, but the area under the plasma concentration-time curve from 0 to 12 hours at steady state was unchanged. As expected, alcohol significantly impaired cognitive function in volunteers. However, fluvoxamine did not potentiate the effects of alcohol and in some instances appeared to reverse the effects or reduce their duration. Fluvoxamine was well tolerated: only mild adverse effects were reported, and none of those required intervention. CONCLUSION: Fluvoxamine does not interact significantly with alcohol or potentiate alcohol-related impairment of cognitive function.

Administration, Oral↗
PubMed1990

A multi-centre open study in general practice to evaluate the efficacy and acceptability of zopiclone 7.5 mg nocte in patients requiring the prescription of an hypnotic.

This was an open study of the efficacy and acceptability of zopiclone 7.5 mg nocte as a somnifacient. The study population comprised 108 insomniac patients (70 female, 38 male) aged 22-74 years who received zopiclone 7.5 mg for 7 consecutive nights. Based on subjective sleep assessments, zopiclone reduced the patients' difficulty in falling asleep, increased the number of hours slept and decreased the number of nocturnal awakenings (p less than 0.001). The majority of patients reported sleeping well or very well. The quality of sleep improved (p less than 0.0001), and the incidence of waking earlier than desired decreased (p less than 0.001), with respect to baseline, after receiving zopiclone. Physicians rated efficacy as good or very good in the majority of patients. Zopiclone was efficacious both in patients who had not previously received hypnotic therapy (n = 37) and in patients who transferred directly to zopiclone from a benzodiazepine hypnotic (n = 26). Whilst receiving zopiclone, patients reported feeling better in the morning than they did prior to treatment (p less than 0.004); 78% expressing satisfaction with zopiclone as an hypnotic. Physicians reported zopiclone treatment to be without side-effects in the majority of patients. In conclusion, zopiclone appears to be an effective and well-tolerated hypnotic that may play a role in the treatment of insomnia in the general population.

Adult↗
PubMed1990

A comparative study of zopiclone and triazolam in patients with insomnia.

Zopiclone, a cyclopyrrolone derivative, was compared with triazolam in a double-blind, randomized, parallel group study in general practice patients suffering from insomnia. Both drugs were found to be effective compared to baseline assessment in that they increased the number of hours of sleep, reduced the number of nocturnal wakenings and reduced the latency of falling asleep. In addition, both drugs improved patients' condition following awakening, with zopiclone showing slight superiority. In both treatment groups, there was a transient period of poor sleep after withdrawal of the drug, and one patient in each group withdrew from the study for this reason. There were no serious adverse reactions during the trial.

Adult↗
PubMed1990

The effect of zopiclone 7.5 mg on the sleep, mood and performance of shift workers.

Shift workers often complain of an inability to sleep well between successive periods of work. The purpose of the study was to assess the influence of zopiclone, hypnotic with minimal residual effects, on work-time performance and mood. In this double-blind, cross-over study, 12 healthy male volunteers, aged between 18 and 35 years, from the Royal Air Force, working 12 h shifts in radar installations, were given zopiclone 7.5 mg at bed time or placebo for 2 shift cycles in a randomized order. Zopiclone significantly improved night time sleep, with a trend towards improvement of day-time sleep. There was no effect on psychomotor performance (assessed by critical flicker fusion threshold, choice reaction time and digit symbol substitution test) nor on mood (assessed by visual analogue scales). It can be concluded that zopiclone is a safe hypnotic which can be used by shift workers without impairing work time performance.

Adolescent↗
PubMed1989

Management of the second stage of labor: a review (Part I).

The second stage of labor is defined as that time from the completion of dilitation of the cervix to the delivery of the infant. Considerable controversy exists in the current obstetric and midwifery literature concerning the appropriate management of this stage of labor. With increased use of regional anesthesia, electronic fetal monitoring and the shift in favor of active management of labor, the second stage is often accompanied by forceful bearing-down efforts, repeated Valsalva maneuvers and an increase in the use of forceps, vacuum extraction and episiotomies. Probably the single strongest point resulting in active intervention in the second stage of labor is the rigid use of the Friedman Curve. This approach tends to insist upon a predetermined time interval and promotes early intervention. The opinions on both sides of this controversy are the topic of this review.

Female↗
PubMed1989

Management of the second stage of labor: a review (Part II). Maternal positioning as it relates to the management of the second stage of labor is reviewed.

In the previous article, the rigid use of the Friedman Curve, breathing techniques, and other management options for the second stage of labor were examined. This article concentrates on the affect of maternal positioning, on the length of the second stage of labor, and summarizes the contents of that former article and this one.

Female↗
PubMed1987

Indomethacin: effects on cold-induced pain and the nervous system in healthy volunteers.

The sensitivity of the cold-induced pain (CP) model to the non-steroidal anti-inflammatory drug (NSAID) indomethacin was studied in healthy volunteers. Effects on the central nervous system were also sought. Subjects received single oral doses of indomethacin 50 and 100 mg, dipipanone 8 mg and placebo, according to a double-blind, randomised, balanced, cross-over design with an interval of 7 days between occasions. A test battery was performed before each treatment and then at 45, 105 and 165 min post treatment. Pain scores were unaltered by indomethacin at either dose, but the drug certainly affected the CNS, increasing respiratory drive and changing self-assessed mood. It is concluded that the CP model is insensitive to indomethacin, even in doses which have clear-cut CNS effects. The respiratory stimulant action of indomethacin may deserve further study.

Adult↗
PubMed1987

Effects of triprolidine and dipipanone in the cold induced pain test, and the central nervous system of healthy volunteers.

1 Twelve healthy volunteers took part in a study of the interaction between the antihistamine triprolidine and the opioid dipipanone in the cold induced pain (CP) test and tests of sedation. They received placebo, triprolidine 2.5 mg, dipipanone 8 mg or the combination of the two active treatments according to a double-blind, randomised, balanced, crossover design. 2 Antihistamine activity was demonstrated by triprolidine reducing the size of wheals and flares produced by intradermal histamine 1.6 micrograms. However, triprolidine produced no analgesia in the CP test, nor did it enhance the analgesia produced by dipipanone alone. 3 Neither treatment alone produced statistically significant sedation, assessed by visual analogue scales (VAS), side effect check list, body sway and reaction times. However, the combination did cause significant sedation. 4 Dipipanone reduced pupil size, depressed respiration, and decreased salivation. Triprolidine had no effects on pupil size and respiration, but reduced salivation slightly. It was concluded that histaminergic (H1) mechanisms are unlikely to be involved in pain produced by cold.

Adult↗
PubMed1987

Dipipanone and nifedipine in cold induced pain; analgesia not due to skin warming.

The mechanism of the pain relief produced by opiates in normal volunteers in the cold induced pain test has been investigated. In a double-blind placebo controlled study, hand skin temperature during a 3 min immersion in water at 1 degree C was not affected by either the opioid dipipanone 8 mg or the vasodilator nifedipine 10 and 20 mg. During this immersion, dipipanone produced significant pain relief. Nifedipine reduced pre-immersion blood pressures and raised heart rates, however, it did not significantly alter pain scores. It is concluded that vasodilatation and local warming do not play a role in the relief of pain by opiates in the cold immersion test.

Adult↗
PubMed1987

Effects of carbon dioxide on mental performance.

Although elevated levels of inspired CO2 have been recorded in work situations, little is known about effects of concentrations greater than 6% on mental performance. We have measured the effects of inhaling 0, 4.5, 5.5, 6.5, or 7.5% CO2 for 20 min on normal young adults unhabituated to CO2. Performance of reasoning tasks, such as AB logic problems, was significantly slowed at the higher levels of CO2, with a threshold at end-tidal PCO2 close to 51 Torr. Accuracy of reasoning and short-term memory were not significantly affected. More prolonged studies with inhalation of 6.5% CO2 showed that after the first 10 min ventilation tended to increase, end-tidal PCO2 to fall, and slowing of reasoning to recover, but substantial decrement in performance continued for 80 min, by which time performance virtually stabilized. On return to air breathing, preexposure performance was resumed within 10 min. Also caused by 6.5% CO2 was a significant rise in subjectively assessed irritability and discomfort, with no significant change in alertness or in either registration or recall of long-term memory.

Adult↗
PubMed1986

External cephalic version: a clinical experience.

Eighty-five normal women underwent external cephalic version (ECV) for breech presentation in the late 3rd trimester. The protocol included real time ultrasonic scanning and pre- and post-procedure electronic fetal monitoring. Subcutaneous terbutaline sulfate (0.25 mg.) was administered to (43/85 or 50.5%) of ECV candidates and rendered the procedure easier for patient and operator. A single operator, head-over-heels technique assisted by supine Trendelenberg's position was used. Rh negative women were routinely administered 300 mcg of immune globulin. Successful ECV (53/85, 62.5%) was related to maternal parity, but not to gestational age nor eventual delivery weight. In this series only engagement of the breech was reliable in predicting ECV failure. Fifty of 51 (98.1%) successfully verted women delivered a cephalic presentation infant at term. Cesarean section was performed in 5/51 of these patients (9.8%) for routine obstetrical indications. In one case, compound presentation at term resulting in dystocia and eventual cesarean section was believed related to prior successful version. In contrast, 15/30 (50%) of the ECV failure patients went on to operative delivery despite a liberal institutional policy toward term vaginal breech trials. In addition, the only serious fetal complication in this series, meconium aspiration, occurred in a vaginally delivered breech infant. It is unlikely that late 3rd trimester ECV will impact on out overall rate of cesarean delivery. In North America prematurity is the greatest risk factor in malpresentation and our policy increasingly is to permit attempts at term breech vaginal delivery. Nonetheless, ECV deserves serious consideration. When successful, ECV avoids the costs and/or risks of either cesarean section or vaginal trial of breech.(ABSTRACT TRUNCATED AT 250 WORDS)

Breech Presentation↗
PubMed1985

Effects of raised body temperature on reasoning, memory, and mood.

Volunteers' body core temperatures were raised to 38.80-39.05 degrees C within a few minutes by immersion in water at 41 degrees C. Tests were then made with the subjects insulated and cooling slowly. Control immersions were made in water at 37 degrees C when core temperatures remained at 36.60-37.40 degrees C. Neither memory registration nor recall of memories registered an hour earlier, nor immediate ability to recall digit spans forward or backward was affected by the increase in core temperature. The increase in temperature did not have any significant effect on accuracy of performance of verbal logic problems or of two-digit subtractions. However, the increase in core temperature was associated with a significant increase in the speed of performance of the tests, by 11 and 10%, respectively. The warm immersions also induced a significant decrease in alertness and an increase in irritability as assessed subjectively by the volunteers; control immersions had no such effects.

Adult↗