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Biomedical subjects

S R Wrigley

Publications and source records attributed to S R Wrigley.

10 recordsLinked to original sources
PubMed2004

Effects of the European Working Time Directive on anaesthetic training in the United Kingdom.

Decreases in the hours worked by trainee anaesthetists are being brought about by both the New Deal for Trainees and the European Working Time Directive. Anticipated improvements in health and safety achieved by a decrease in hours will be at the expense of training time if the amount of night-time work remains constant. This audit examined the effects of a change from a partial to a full shift system on a cohort of trainee anaesthetists working in a large district general hospital in the South-west of England. Logbook and list analyses were performed for two 10-week periods: one before and one after the decrease in hours. An 18% decrease in the number of cases done and an 11% decrease in the number of weekly training lists were found for specialist registrars. A 22% decrease in the number of cases done and a 14% decrease in the number of weekly training lists were found for senior house officers. Furthermore, a decrease of one service list per specialist registrar per week was seen, which will have implications for consultant manpower requirements.

Anesthesiology↗
PubMed1998

Pre-operative fasting for paediatric anaesthesia. A survey of current practice.

There has recently been much debate about pre-operative fasting for paediatric anaesthesia. There is no consensus about the optimum fasting times for children undergoing elective surgery. In order to establish a standard for paediatric pre-operative fasting times, we undertook a postal survey, targeting members of the Association of Paediatric Anaesthetists resident in the United Kingdom and Ireland in 1995. One hundred and sixty-three questionnaires were dispatched, 131 (80%) were returned and 110 (67%) were complete. The results show that the following guidelines for duration of fast are acceptable to the majority of respondents-neonates: 2 h for clear fluids, 4 h for breast and formula milk; infants: 2 h for clear fluids, 4 h for breast milk, 6 h for formula milk and solids; children: 2 h for clear fluids, 6 h for milk and solids. We suggest that these times be used as guidelines and audited for pre-operative fasting in paediatric anaesthesia.

Adolescent↗
PubMed1995

A fibreoptic laryngoscope for paediatric anaesthesia. A study to evaluate the use of the 2.2 mm Olympus (LF-P) intubating fibrescope.

A technique for the use of the Olympus LF-P as an aid to tracheal intubation, via the oral route, in 40 anaesthetised, spontaneously breathing children is described. The technique was completely successful in 30 (75%) of the children. Complications occurred in the remaining ten (25%); two developed laryngospasm and in seven the fibrescope flipped out of the trachea during the initial passage of the tracheal tube over the fibrescope. In one child the wrong tracheal tube was initially chosen. The two children who developed laryngospasm and three of the children in whom the fibrescope flipped out of the trachea required conventional laryngoscopy and tracheal intubation. Whilst this technique allowed for training in the use of the LF-P in paediatric anaesthesia there were a number of complications.

Child↗
PubMed1994

Comparison of desflurane and fentanyl-based anaesthetic techniques for coronary artery bypass surgery.

We have compared, in 51 ASA II and III patients undergoing coronary artery bypass surgery, an inhaled anaesthetic technique based on desflurane, supplemented with low-dose (10 micrograms kg-1) fentanyl, with an i.v. technique using high-dose (50 micrograms kg-1) fentanyl with midazolam for induction. Satisfactory records were available for analysis in 50 patients. There were no differences between groups in operating time, cardiopulmonary bypass time, aortic cross-clamp time or duration of stay in the intensive care unit after surgery. Desflurane maintained mean systemic arterial pressure at the awake level during incision and sternotomy (end-tidal concentrations 3.7% and 4.6%, respectively) but decreased it significantly at all other times. With fentanyl, mean systemic arterial pressure was unchanged from awake values during induction and laryngoscopy but increased significantly at incision and sternotomy by 8% and 12.8%, respectively, to exceed the desflurane group at sternotomy by 20 mm Hg (P < 0.001). With desflurane, heart rate remained at 60-67 beat min-1 at all times before cardiopulmonary bypass. This was always lower than the fentanyl group by 5-15 beat min-1 and the difference was significant at induction, during skin preparation and before aortic cannulation. In comparison with the desflurane group, cardiac index was significantly greater in the fentanyl group at induction, laryngoscopy and during skin preparation, but was significantly less before aortic cannulation. The need for vasodilator intervention was significantly more common in the fentanyl group before, during and after cardiopulmonary bypass and for beta adrenoceptor block before cardiopulmonary bypass.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Mivacurium chloride: a study to evaluate its use during propofol-nitrous oxide anaesthesia.

We assessed the neuromuscular and cardiovascular effects of mivacurium chloride, a neuromuscular blocking agent, in 33 patients during propofol-nitrous oxide anaesthesia. Neuromuscular function was assessed with supramaximal stimuli of the ulnar nerve, using surface electrodes at the wrist, with repeat trains of four. Mivacurium given as a bolus of 0.15 mg.kg-1 (ED95 x 2) was found to be haemodynamically stable. Intubating conditions assessed at 2 and 2.5 min were either good or excellent. All patients developed a block of 100% in a mean (SD) time of 105 (34) s. There were mean (SD) intervals of 12 (2.4) min before the reappearance of the first twitch of the train of four (T1) following the bolus dose, and 15.8 (3.1) min for the T1 to reach 25% of its control value (TC). Seventeen patients received an infusion of mivacurium to maintain neuromuscular blockade (T1:TC 10-20%) with a mean (SD) infusion rate of 6.9 (2.2) micrograms.kg-1.min-1. Recovery from neuromuscular blockade was assessed with spontaneous offset or augmented with edrophonium following either the initial bolus or an infusion. Following a bolus it took a mean (SD) of 26.2 (3.7) min for the fourth twitch of the train of four (T4):T1 ratio to reach 0.7. In patients receiving an infusion with spontaneous offset it took a mean (SD) time of 12.0 (2.2) min to reach the T4:T1 ratio of 0.7 from a T1:TC value of 8.8. Edrophonium significantly decreased the recovery time in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Resistance to atracurium in a patient with an increase in plasma alpha 1 globulins.

We observed that a female patient with a poorly differentiated adenocarcinoma of the stomach undergoing gastrectomy was markedly resistant to the action of the neuromuscular blocking drug atracurium. There was no evidence of tumour metastasis and her liver function tests were normal. Electrophoresis of plasma proteins revealed a marked increase in alpha 1 globulin. Alpha 1 acid glycoprotein is an acute phase reactant that is increased in patients with cancer and is present in the alpha 1 globulin electrophoresis pattern. It is likely that the mechanism for the resistance to neuromuscular block in the patient was an increase in drug binding to alpha 1 acid glycoprotein.

Adenocarcinoma↗
PubMed1991

Induction and recovery characteristics of desflurane in day case patients: a comparison with propofol.

Desflurane is an ether halogenated exclusively with fluorine. It has a blood/gas partition coefficient of 0.42 (cf. isoflurane 1.40 and nitrous oxide 0.46). This characteristic suggests that it should provide both a fast induction of anaesthesia and a rapid recovery from anaesthesia. To assess this, 60 patients were entered into a study and allocated at random to one of four groups receiving either desflurane or propofol for induction and maintenance of anaesthesia. Desflurane caused loss of consciousness in approximately 2 minutes during gaseous inductions. The psychomotor scores in the patients who received propofol for induction and maintenance of anaesthesia were significantly worse compared with those who were given desflurane for either induction and maintenance or for maintenance only. There was also a tendency for other recovery parameters to be faster in the patients receiving desflurane although this did not reach statistical significance. This suggests that desflurane would be a suitable agent for day case anaesthesia providing for a rapid recovery.

Adolescent↗
PubMed1990

The laryngeal mask airway in paediatric anaesthesia.

Forty-eight children, aged between 2 and 10 years, admitted as day cases for otological surgery were allocated at random into two groups. The first group was anaesthetised using a standard facemask, and the second with a laryngeal mask airway. The laryngeal airway produced a satisfactory airway in all children, and was inserted on the first attempt in 67% of patients. Hypoxia was significantly less frequent in the laryngeal airway group (p less than 0.05), and there were significantly fewer interruptions to surgery than in the facemask group (p less than 0.001). Patient safety, operating and anaesthetic conditions were all considered superior in the laryngeal airway group.

Ambulatory Surgical Procedures↗