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Biomedical subjects

W W Mapleson

Publications and source records attributed to W W Mapleson.

At least 19 recordsLinked to original sources
PubMed1992

Effects of posture, phonation and observer on Mallampati classification.

We have studied the effects of phonation and posture on the Mallampati classification of view of the pharyngeal structures. Differences between observers were allowed for by the experimental design and log-linear modelling. Sixty-four patients were assessed on the ward, sitting upright, with and without phonation, by each of two observers. Another 64 patients were assessed without phonation, but both upright and supine, again by both observers. Phonation (the patient saying "Ah") produced a marked, systematic improvement of view; moving to the supine posture produced a small, systematic, non-significant worsening of the view. Differences between observers were non-systematic but substantial. About 25% of patients phonated spontaneously. It is recommended that anaesthetists make their own assessments of Mallampati classification, with the patient in either of the postures but always either with or without phonation, and thereby gradually "calibrate" their assessments against the degree of difficulty encountered in intubation.

Humans↗
PubMed1992

A model lung with direct representation of respiratory muscle activity.

We describe the theory, construction and testing of an active model lung. This is designed so that when it is connected to a ventilator, the interaction between spontaneous ventilatory activity in the patient and the pressures and flows generated by the ventilator are reproduced faithfully. A waveform of negative pressure, pmus, equivalent to the action of the respiratory muscles, is applied indirectly to the compliance unit of a conventional model lung. It is shown that, when the compliance and resistance of a subject have been measured, the waveform of pmus can be determined. This was undertaken in three volunteers breathing under various conditions, including connection to a ventilator operating in different modes. When these conditions were reproduced with the lung model replacing, but matched to, each subject, the original waveforms of flow and pressure at the mouth were reproduced.

Adult↗
PubMed1991

Comparison of arterial and arterialized venous concentrations of propofol during infusion of propofol.

Seven patients received a series of low-dose propofol infusions designed to produce three successive pseudo-steady states of arterial blood concentration: 0.06, 0.17 and 0.43 micrograms ml-1. Arterial and arterialized venous blood samples were obtained simultaneously at the end of each infusion. The results indicate that 95% of the arterialized venous concentrations may be expected to lie within 1 +/- 43% of the corresponding arterial concentration, or -5 +/- 35% if one set of measurements with poor agreement between duplicate aliquots is omitted.

Arteries↗
PubMed1991

Effect of sub-anaesthetic infusions of propofol on peak velocity of saccadic eye movements.

Peak velocity of saccadic eye movements was studied in six healthy volunteers who received either 0.9% sodium chloride (as a control) or a stepwise rising propofol infusion regime of 0.24, 0.6 and 1.5 mg kg-1 h-1, which produced arterialized venous concentrations equivalent to 1%, 6% and 13% of the estimated EC50 for propofol. The infusion lasted for 75 min (25 min at each infusion rate) and was followed by a 2-h post-infusion recovery period. Peak saccadic velocity was highly significantly depressed during the 15-25-min period after the start of the second and third propofol infusions compared with saline. The relationship between arterialized venous blood concentration and peak saccadic velocity was similar during recovery when concentrations were falling to that during increasing blood propofol concentrations. Peak saccadic velocity decreased linearly with increasing log10 propofol concentration in the range of 25-800 ng ml-1 (14% of control per decade). Measured arterialized venous-blood propofol concentrations were variable, and systematically greater than computer predictions at the two higher infusion rates. In only half the subjects were the subjective assessments significantly correlated with log10 propofol concentrations or with percentage reduction in peak saccadic velocity.

Adult↗
PubMed1979

From Clover to computer. Towards programmed anaesthesia?

The control of depth of anaesthesia has been viewed as a control-system problem the solution of which can involve both feedback and feedforward techniques. The nature of the problem in Clover's day and the solutions he found have been examined. A similar analysis has been made in respect of the modern anaesthetist. Finally, the way in which computers may aid the anaesthetist in his task has been illustrated by reference to various attempts reported from around the world and, in particular, by describing the development in Cardiff of a system which should produce, in the brain of the patient, any tension of an inhaled anaesthetic which the anaesthetist chooses to specify.

Anesthesia, Inhalation↗
PubMed1977

Halothane solubility in human blood.

In a study of the influence of nutritional state on halothane anaesthesia, results were obtained which showed how the blood/gas partition coefficient for halothane varied with blood chemistry in 20 patients undergoing elective surgery. For each patient the partition coefficient lambda was measured by equilibration at 37 degrees C of a blood sample with a 1% halothane in 5% carbon dioxide in air mixture, followed by chemical extraction and estimation of the halothane content by gas chromatography. The haematocrit and haemoglobin, serum albumin, total protein, triglyceride and cholesterol concentrations were measured by routine laboratory methods. Regressions were sought of lambda on each of these, and on the globulin concentration and the ratios of albumin: globulin and albumin: total protein, deduced from these determinations. The only statistically significant regression (P = 0.0004) was that of lambda on the serum triglyceride concentration (T) (mmol/litre): lambda = 1.83 + 0.424T. The dependence of lambda on haemoglobin concentration was not statistically significant, but the slope of the regression was consistent with those of previous investigators. The regressions of lambda, corrected to the mean triglyceride concentration, on the ratios of albumin: globulin and albumin: total protein were not statistically significant but were not significantly different from an earlier reported result.

Anesthesia, Inhalation↗
PubMed1977

Urinary excretion and metabolism of pethidine and norpethidine in the newborn.

In seven neonates, whose mothers were given pethidine during labour, urine was collected for the first 24-40 h of life. Urinary volume and pH, and concentrations of pethidine and norpethidine in the urine were measured. Urine flow rate was low for the first 7-22 h, and then high for about 12 h. The rate of excretion of pethidine and norepethidine was approximately parallel to the urine flow rate. However, the ratio of the rate of excretion of norpethidine to that of pethidine increased with time and the concentration of norpethidine in urine decreased first and then, after 18 h, increased significantly. These findings that the neonate can metabolize pethidine, although the rate of metabolism is probably less than in the adult. The total amounts of pethidine and norpethidine excreted in the first 24 h after birth were positively related to the dose-delivery interval in the mother for intervals up to at least 5 h. From the data it is estimated that 95% of the total pethidine transferred from the mother would be eliminated by the baby by the 2nd to 3rd day after birth.

Humans↗
PubMed1977

Adiposity and the pharmacokinetics of halothane. The effect of adiposity on the maintenance of and recovery from halothane anaesthesia.

Thirty fit patients (15-70 years, 46-98 kg) undergoing body-surface operations were selected to include a wide range of adiposity (12-45% of total body weight estimated from measurements of skinfold thickness). They were anaesthetized with halothane and 70% N2O in O2. From measurements of total ventilation (ml min-1 kg-1) and of halothane concentrations in inspired (F1) end-tidal (FE') and 'mixed-spill' (FS) gases, the following parameters were calculated for 5-min intervals from 20 to 40 min after induction; the rate of uptake of halothane per percent inspired concentration (Vha1 ml min-1%-1) and the degree of equilibrium achieved with the inspired concentration, calculated as FE'/F1 expressed as a percentage. Multiple-regression analysis of the results for 19 patients, taking account of the effects of body fat, ventilation, age, and the blood-gas partition coefficient lambda of halothane for the individual patient, showed that Vha1 increased with adiposity (b=0-375, P=0-0019), and with ventilation (b=0-054, P=0-09) but decreased with increasing age (b=-0-258, P=0-006). The time intervals between the end of the anaesthetic and the achievement of four defined levels of recovery (response to painful stimulus obedience to a simple command, response to a question, orientation in time and space), were recorded. Multiple-regression analysis showed that recovery time increased with addiposity, duration of administration and end-tidal concentration at the end of the administration, and decreased with increasing age. All four effects were statistically non-significant at the first levels of recovery but all increased at the later levels and all eventually became significant.

Adolescent↗
PubMed1977

The Cardiff Aldavac anaesthetic-scavenging system.

The Cardiff Aldavac system consists of a reservoir, adsorption canister, flow restrictor and the necessary pipe connections. It enables theatre pollution control without structural alteration or special installation. It utilizes the hospital piped medical vacuum system but protects the system from excessive flows or contamination by volatile anaesthetics and still allows the vacuum to be used for other purposes.

Anesthesiology↗
PubMed1976

Pharmacokinetics of halothane in the dog. Comparison of theory and measurement in individuals.

After surgical preparation under pentobarbitone anaesthesia seven dogs of mean body weight 31 kg were ventilated with 1% halothane for 80 min. At 1, 2, 5, 10, 20, 40 and 80 min after the start of the halothane administration blood samples were taken from the femoral artery and pulmonary artery and from a cerebral, a renal and a femoral vein. At 80 min a biopsy sample of skeletal muscle (psoas) was taken. The halothane tension in all samples was determined by extraction into carbon tetrachloride followed by gas chromatographic analysis using chloroform as an internal standard. The measured tensions were compared with tensions computed from a multi-compartment model of the uptake and distribution of halothane in the body. The model was quantified by measurements, in each individual, of total body mass, the masses of the major organs and the solubility of halothane in the major organs and tissues; by measurements of blood volume and solubility in blood at the start and finish of the halothane administration; and by repeated measurements of alveolar ventilation, cardiac output and body temperature. For the original version of the model, the computed tensions deviated from the measured tensions to an extent greater than could be attributed to experimental error and in a manner which could be attributed to metabolism of halothane and probably to direct diffusion of halothane from well-perfused organs and lean tissues into fat. Direct experimental evidence of diffusion into perirenal fat was obtained in supplementary experiments. With the quantitation of the model distorted to mimic the processes of metabolism and diffusion, measured arterial tensions could be predicted with a mean error of -0.2 mm Hg (SD 0.6 mm Hg). The mean measured arterial tension was 3.5 mm Hg.

Animals↗
PubMed1975

Effects of changes of frequency and tidal volume of controlled ventilation: measurements at constant arterial Pco2 in dogs.

Seven Alsatian dogs were anaesthetized with thiopentone, paralysed with pancuronium, and ventilated with 1% halothane in a mixture of air and oxygen in such a way as to maintain Paco2 at 40 mm Hg and Pao2 at 150 mm Hg. From various respiratory and circulatory measurementts the following variables were determined: physiologicaldeadspace, cardiac output, venous admixture, respiratory compliance and resistance, and oxygen and carbondioxide exchcnage. After a controlseries of measurements at a ventilator frequency of was doubled to 50/min and adjustments to tidal volume and inspired oxygen concentration made to maintain constancy of blood gas tensions. The same procedure was followed again at 25/min, l/min and finally at 25/min. At each frequency the I:E ratio was kept at 1/2, the shape of the inspiratory flow waveform was kept constant (a rapid increase followed by a steady decline to zero) and expiration was passive to atmosphere. Mean results showed that physiological deadspace changed relatively little with frequency so that the deadspace:tidal volume ratio increased significantly on changing to 50/min (by 24%) and decreased significantly on changing to 6/min (by 46%). Changes of cardiac output and venous admixture were either not significant or on the borderline of significance and the 95% confidence limits of these changes were within +14%, --12% for cardiac outpur and within plus or minus1.4% of cardiac output for venous admixture. Tt is concluded that, provided Paco2 and Pa02 and mean air way pressure are kept constant, the frequency of ventilation is not important, even over a wide range of values.

Airway Resistance↗
PubMed1975

Rebreathing in a T-piece: volunteer and theoretical studies of the Jackson-Rees modification of Ayre's T-piece during spontaneous respiration.

The Jackson-Rees modification of Ayre's T-piece was examined experimentally and theoretically to see what effects the theoretical restrictions of Onchi, Hayashi and Ueyama (1957) (1:1 I:E ratio, zero deadspace volume) and the square-wave approximation of Mapleson (1958) may have had on the calculated critical fresh-gas flow rate necessary to prevent rebreathing of exhaled alveolar gases. In the experimental examination six conscious alert volunteers breathed through the system as the fresh-gas flow rate was varied in steps, and their ventilation was recorded at each value. Assuming that under rebreathing conditions a normal arterial PCO2 is maintained by hyperventilation, this experimental situation is identical with one of the two considered theoretically by assuming sine-wave inspiratory and expiratory waveforms, zero longitudinal mixing in deadspace volumes and perfect mixing in the alveoli. Agreement between experimental and theoretical results justifies the assumptions made in the theoretical analysis and the results indicate that a fresh-gas flow rate of about twice the normal ventilation is necessary to eliminate rebreathing completely from the Jackson-Rees modification of Ayre's T-piece. The exact requirement depends on the deadspace/tidal volume (VD/VT) and I:E ratios. The onset of hyperventilation at lower fresh-gas flow rates is gradual and, in spontaneous breathing with VD/VT approximately equal to 40% and I:E ratio = 1:1.2, is only 10-20% at a fresh-gas flow rate of 1.5 times the normal ventilation.

Anesthesia, Inhalation↗
PubMed1975

The solubility of halothane in canine blood and tissues.

In vitro measurements were made of the solubility of halothane (about 1%, carried in 5% carbon dioxide in air) in tissues taken from dogs, mostly Alsatians, and usually after about 8 hr anaesthesia with pentobarbitone and halothane. The mean Ostwald solubility coefficient lambda in atm- minus 1 at 37 degrees C, for seven to 21 animals, were: brain 6.03, gut 4.23, cardiac muscle 4.88, kidney 4.95, liver 6.64, skeletal muscle (psoas) 5.45. For the gracilis muscle solubilities up to 20 atm- minus 1 were obtained. Solubility in blood was shown to increase significantly with haematocrit and haemoglobin and to be significantly higher in blood from unanaesthetized than from anaesthetized animals. The best-estimate equations were lambda-2.38 + 0.042H for the unanaesthetized condition and lambda-1.69+0.049 H for the anaesthetized condition, where H is haematocrit %. Combining the present results with those for other species showed that the solubility of halothane increased fairly systematically from blood to kidney to brain to liver, and from ox to man to dog to rabbit.

Anesthesia↗