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Biomedical subjects

R S Vaughan

Publications and source records attributed to R S Vaughan.

At least 73 records · Page 4Linked to original sources
PubMed1990

A jet nebuliser for delivery of topical anesthesia to the respiratory tract. A comparison with cricothyroid puncture and direct spraying for fibreoptic bronchoscopy.

Topical anesthesia of the respiratory tract for fibreoptic bronchoscopy was compared, in a single-blind study, inhaled from a simple and inexpensive jet nebuliser, administered by cricothyroid injection or by a 'spray-as-you-go technique'. Each technique was supplemented by spraying lignocaine through the fibrescope and intravenous fentanyl-droperidol sedation. Inhaled nebulisation was successfully used for 96% (46 of 48) of patients, was safe, effective and acceptable to the patient and bronchoscopist. The cricothyroid injection method produced better conditions than nebulisation in patients who had diagnostic bronchoscopy. The nebuliser technique is as satisfactory as the spraying technique in patients for diagnostic bronchial lavage in whom bleeding from a cricothyroid puncture is unacceptable. Patients who used the nebuliser were more satisfied. This technique may also be a useful method for 'awake' intubation.

Administration, Inhalation↗
PubMed1990

Pregnancy associated with Gorlin's syndrome.

A pregnant woman with Gorlin's syndrome presented for the removal of malignant ovarian tumours. The main problem encountered by the anaesthetists was an unexpected increase in arterial blood pressure. This was most probably associated with surgical manipulation of the ovaries with an increase in prorenin/renin production.

Adult↗
PubMed1989

Airways revisited.

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Anesthesiology↗
PubMed1989

Intravenous enalaprilat and autonomic reflexes. The effects of enalaprilat on the cardiovascular responses to postural changes and tracheal intubation.

Thirty healthy patients, who were to undergo surgery which required tracheal intubation, were given an intravenous injection of enalaprilat (either 0.5 mg, 1 mg, 2 mg or 4 mg; six patients for each dose) or normal saline 17 minutes before induction of anaesthesia with thiopentone 3-5 mg/kg, and suxamethonium 1.5 mg/kg. Postural manoeuvres were performed 5 minutes before and 6, 11 and 16 minutes after enalaprilat or saline. Complete inhibition of angiotensin converting enzyme occurred with all doses of enalaprilat, which allowed the four different treatment groups to be considered as one large treated group. The mean arterial pressure was almost unchanged during the postural manoeuvres; the heart rate increased, mostly similarly (by approximately 10%) in both groups. Mean arterial pressure in the recumbent position decreased over the 17 minutes before induction in the enalaprilat group, and increased slightly in the control group (treated mean, -5.0%; controls mean, 1.8%; difference, -6.8%; 95% confidence intervals of difference, -2.3 to -11.3%, p less than 0.01). This difference was again seen after induction (treated, -8.0%; controls, 7.7%; confidence intervals of difference, -0.6 to -31%) and for a 5-minute period shortly after tracheal intubation. The increases in mean arterial pressure produced by intubation itself were similar in both groups (treated, + 36%; controls, + 35%; 95% confidence intervals of difference, -16% to + 18%). Changes in heart rate after induction were also similar in both groups. It is concluded that intravenous enalaprilat acted as a hypotensive agent with a sparing effect on autonomic reflexes, both before and after induction of anaesthesia.

Adult↗
PubMed1988

Delayed recovery from general anaesthesia.

A case of postoperative coma associated with diabetes insipidus and hypothermia is presented. Some recommendations are offered for the future management of similar cases.

Anesthesia Recovery Period↗
PubMed1988

The control of post-thoracotomy pain. A comparative evaluation of thoracic epidural fentanyl infusions and cryo-analgesia.

This is a comparative study of two methods to relieve postoperative thoracotomy pain. Continuous thoracic epidural infusion of fentanyl produced superior analgesia when compared with cryo-analgesia of the relevant thoracic nerves. Linear analogue pain scores were consistently lower in the epidural group reaching significance (p less than 0.05) at 32 and 40 hours after operation. All 36 patients in the cryo-analgesia group required additional analgesia, while 12 out of the 32 patients in the epidural group did not. This difference was significant at p less than 0.001. Respiratory and cardiovascular measurements were similar in both groups and the only side effect attributable to the epidural fentanyl was itching but this was not a problem.

Analgesia↗
PubMed1987

Comparison of temazepam elixir and trimeprazine syrup as oral premedication in children undergoing tonsillectomy and associated procedures.

Temazepam 0.5, 1.0 and 1.5 mg kg-1 in an elixir formulation (Euhypnos Elixir), was compared with trimeprazine tartrate 3 mg kg-1 in a syrup (Vallergan Forte Syrup), as premedication in 220 children (ASA grade I) undergoing tonsillectomy and associated procedures. Each patient was randomly allocated to one of the four treatments. The administration was blind to the observers in theatre, recovery room and postoperative ward, who assessed each patient according to a total of 14 criteria. A modelling technique allowed account to be taken of the effects of concomitant variables (e.g. age and duration of anaesthesia) where appropriate. No statistically significant difference was found between the efficacy of the treatments. The only statistically significant differences were that temazepam was associated with more ectopic beats under anaesthesia (P = 0.03 or 0.002, depending on the test applied), more postoperative vomiting (P = 0.04) and more postoperative restlessness (P less than 0.0001).

Adolescent↗
PubMed1985

Use of intravenous regional sympathetic block in upper limb angiography.

An intravenous regional sympathetic block was produced in the upper limb using a Bier's technique and guanethidine. The dilatation produced allowed accurate delineation of the vasculature at angiography which could be reproduced after further injections of contrast medium. It is further suggested that this technique may be used immediately before tissue grafting as it may prevent vasoconstriction at any anastomotic sites.

Adult↗
PubMed1982

Educated cheek.

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Cheek↗
PubMed1981

The development of respiratory syncytial virus-specific IgE and the release of histamine in nasopharyngeal secretions after infection.

We studied the development of respiratory syncytial virus (RSV)-specific IgE and the release of histamine in nasopharyngeal secretions from 79 infants with various forms of respiratory illness due to RSV. RSV-IgE was measured by an enzyme-linked immunosorbent assay; specificity was confirmed by appropriate blocking experiments. Histamine content in the secretions was determined by fluorimetric methods. RSV-IgE was detectable in only one of 19 patients with RSV infection without wheezing, but was detectable in the majority of 60 patients with wheezing (P less than 0.01). Titers of RSV-IgE were significantly higher in patients with wheezing (P less than 0.05). Histamine was detectable in secretions of some patients with all forms of illness but was detected significantly more often (P = 0.05) and in higher concentrations in patients with wheezing. Peak titers of RSV-IgE and concentrations of histamine correlated significantly with the degree of hypoxia (P less than 0.001). Formation of RSV-specific IgE and release of histamine may adversely affect the outcome of RSV infection.

Age Factors↗
PubMed1981

A new approach to artificial expansion and ventilation of the lung in the severely asphyxiated neonate.

In severe asphyxia, expansion of the newborn lung must precede ventilation by intermittent positive pressure. Inadequate expansion may lead to hypoxia and excessive expansion to rupture of the lung. The only way in which a predetermined pressure can be achieved, and not exceeded in the alveoli, is by applying that pressure at the mouth and waiting until all flow ceases. Applying pressure in this way and increasing it according to a "staircase" pattern, with appropriate steps at suitable intervals, should ensure that the maximum pressure produced in the alveoli is no greater than the minimum necessary for resuscitation in each individual infant. On the basis of published work, ranges of optimum values for the increments and time intervals are suggested. Clinical judgement is still necessary to select from within these ranges, but this "pressure staircase" method should provide a systematic approach to the problem. A suitable apparatus is described.

Asphyxia Neonatorum↗
PubMed1980

Minimum artificial lung expansion necessary for resuscitation of the newborn lamb.

In a group of seven lambs, pressure-volume relationships were obtained for the initial artificial expansion of the lungs in the intact chest and subsequent re-expansion afer the lungs had been excised and collapsed. In a second group, of 12 severely asphyxiated lambs, the lungs were expanded in steps and circulatory resuscitation was achieved at pressures ranging from 1.75 to 3.5 kPa, geometric mean 2.3 kPa, with estimated corresponding volumes of 3--24 ml kg-1, geometric mean 5.8 ml kg-1. In a third group, of 24 severely asphyxiated lambs (mean pH 6.84), 22 were successfully resuscitated in the same manner and nine of these survived in apparent good health for more than 6 months. Any resuscitation regime for human neonates should take account of the finding that resuscitation occurred at pressures less than those necessary for full expansion and that, after the first sign of an increase in heart rate, there was a delay of 17--45 s before full circulatory improvement and of 3 min before full improvement in PaO2.

Animals↗
PubMed1980

An unusual case of Mendelson's syndrome.

A patient aspirated soup 36 h after delivery, developed Mendelson's syndrome but survived. She was small and fat and was immobilized in bed for longer than usual because of inadvertent dural puncture; these factors are thought to have predisposed to the accident.

Adult↗