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Biomedical subjects

W J Fawcett

Publications and source records attributed to W J Fawcett.

At least 19 recordsLinked to original sources
PubMed2003

Recurarization in the recovery room following the use of magnesium sulphate.

A 67-yr-old man weighing 104 kg, with a history of hypertension, underwent laparoscopic cholecystectomy. His preoperative serum potassium was 3.4 mmol litre(-1). The patient received cisatracurium 14 mg, which was antagonized with neostigmine 2.5 mg and glycoprolate 0.5 mg at the end of the procedure. A repeat dose of neostigmine 2.5 mg and glycoprolate 0.5 mg was required 5 min later, as the neuromuscular block was incompletely antagonized. He was transferred to the recovery room about 10 min after the end of surgery, having had recovery of neuromuscular function demonstrated with no fade on peripheral nerve stimulation at 50 Hz for 5 s. Five minutes later he developed rapid atrial fibrillation, which was treated over 5 min with magnesium sulphate 2 G i.v. Within the next 3 min, the patient developed marked neuromuscular weakness of a non-depolarizing pattern leading to respiratory arrest. This necessitated re-intubation of the trachea and artificial ventilation for 20 min, until there was spontaneous recovery of neuromuscular function demonstrated by peripheral nerve stimulation. Administration of magnesium appears to have caused recurarization in this patient. The dose of magnesium alone would not be expected to cause muscle weakness. Potentiation of neuromuscular blocking drugs by magnesium is well recognized, and we recommend its use is avoided for at least 30 min after reversal of neuromuscular block.

Aged↗
PubMed1999

Efficacy of epidural blood patch in the obstetric population.

A retrospective audit of obstetric epidurals was performed at Royal Surrey County Hospital. The aim was to determine the efficacy of epidural blood patch in the management of post-dural puncture headache following inadvertent dural puncture in the obstetric population, over a 5-year period between March 1993 and February 1998. During that time, there were 55 recognized dural punctures (overall incidence 0.96%). A total of 62 epidural blood patches were performed in 48 patients. Following treatment with one epidural blood patch, 33% of patients obtained complete and permanent relief, 50% partial relief and 12% no relief. Twenty-nine percent of patients required a second epidural blood patch of which 50% were completely successful, 36% were partially successful and 14% gave no relief.

Journal Article↗
PubMed1999

Magnesium: physiology and pharmacology.

Magnesium has an established role in obstetrics and an evolving role in other clinical areas, in particular cardiology. Many of the effects involving magnesium are still a matter of controversy. Over the next decade, it is likely that improvements in the measurement of magnesium, a clearer understanding of the mechanisms of its actions and further results of clinical studies will help to elucidate its role, both in terms of treating deficiency and as a pharmacological agent.

Arrhythmias, Cardiac↗
PubMed1997

Thoracic epidural analgesia started after cardiopulmonary bypass. Adrenergic, cardiovascular and respiratory sequelae.

The effects of thoracic epidural analgesia started after cardiopulmonary bypass were studied on the subsequent adrenergic, cardiovascular and respiratory responses. Sixteen cardiac surgical patients received either a standardised general anaesthetic (control group) or a standardised general anaesthetic and thoracic epidural analgesia (epidural group). The epidural catheter was sited before surgery and heparinisation. Following discontinuation of cardiopulmonary bypass, patients in the epidural group were given 15 ml bupivacaine 0.5% down the catheter followed by an infusion of bupivacaine 0.375% at 5-8 ml.h-1 after surgery. The control group received an intravenous morphine infusion on completion of surgery. The adrenergic response was assessed by measuring arterial catecholamine concentrations. Respiratory function was determined by spirometry, peak expiratory flow and arterial partial pressure of oxygen while breathing air. Pain scores were also obtained. After cardiopulmonary bypass the increases in catecholamine concentrations were effectively inhibited in the epidural group for the remainder of the study (p < 0.05). Postoperative respiratory function was less impaired in the epidural group, with higher forced expiratory volume in 1 s, forced vital capacity and peak expiratory flow (p < 0.05). Pain scores were also significantly lower in the epidural group (p < 0.05). There were no significant differences in cardiovascular parameters.

Aged↗
PubMed1996

Vocal fold palsy after use of the laryngeal mask airway.

We report two cases of left vocal fold palsy following use of the laryngeal mask airway. In both cases anaesthesia was uneventful with a duration of about 60 minutes. It is proposed that high intra-cuff pressures induced during anaesthesia resulted in distension of the hypopharynx and subsequent neuropraxia of the motor branches of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve.

Anesthesia, Inhalation↗