Biomedical subjects
S P McHale
Publications and source records attributed to S P McHale.
A survey of nasotracheal intubating skills among Advanced Trauma Life Support course graduates.
The American College of Surgeons' Advanced Trauma Life Support procedure teaches that blind nasotracheal intubation should be performed in the presence of a suspected or proven cervical spine injury in an unconscious but breathing patient who requires an artificial airway. We studied a group of non-anaesthetically trained graduates of the Advanced Trauma Life Support course and examined their skill in performing blind nasal intubations. Only six in 90 attempts were successful. We conclude that, in British hospitals, blind nasotracheal intubation should not be recommended as the first line management in securing the airway of patients with suspected or proven cervical spine injury. Alternative techniques such as bag-and-mask ventilation with cricoid pressure or a laryngeal mask airway with cricoid pressure should be adopted until oral intubation with in-line traction is performed.
Etidocaine and extradural somatosensory evoked potentials after posterior tibial nerve stimulation.
We have examined the effects of lumbar extradural administration of 1% etidocaine 10 ml on somatosensory evoked potentials to posterior tibial nerve stimulation measured in the cervical extradural space. Eight patients, anaesthetized with propofol and nitrous oxide, were studied before hysterectomy and a control group received a similar anaesthetic and 0.9% sodium chloride solution 10 ml in the lumbar extradural space. Etidocaine decreased significantly overall amplitude of the evoked potentials and the amplitudes of all peaks, between 30 and 50 min after extradural injection. The effects of etidocaine on spinal cord conduction were greater than those found previously for lignocaine and bupivacaine, suggesting that it is the local analgesic of choice for inhibiting afferent conduction.
Fatal pulmonary embolism following spinal anaesthesia for caesarean section.
Pulmonary embolism remains one of the commonest causes of maternal death. Regional blockade is reported to decrease the incidence of postoperative thrombo-embolic disease. We describe a case in which a fatal pulmonary embolism followed an emergency Caesarean section for which the patient was given a spinal anaesthetic. We believe it to be the first time this has been reported.
Anaphylactoid reaction to propofol.
A case of an anaphylactoid reaction following the induction of anaesthesia is reported. Subsequent intradermal testing suggested propofol to be the causative agent.