PubMed Health⌕ Search

Biomedical subjects

A Bodenham

Publications and source records attributed to A Bodenham.

At least 37 records · Page 2Linked to original sources
PubMed1993

A review of 2000 consecutive ICU admissions.

The working practices and outcomes from UK intensive care units are poorly documented to date. We have reviewed 2000 consecutive admissions to one intensive care unit in a tertiary referral centre with initially six, then eight beds. The study was a retrospective review of contemporaneous data collection within the period 1986-1990. Demographic details, referral source, admission time, admission diagnosis, APACHE II score, therapeutic interventions, and outcome were recorded. A high overall mortality in the intensive care unit (23%), proportional to APACHE II scoring on admission, was demonstrated. This reflects the referral of many patients who have, or who develop, multiple organ failure. Mortality was significantly higher in patients over the age of 40 years. A total of 69.5% of patients were admitted outside the hours 0800-1800 h on Monday to Friday and admissions peaked between 1200 and 2100 h, demonstrating the need for senior out-of-hours cover. These figures may be used to compare future mortality and work practices in this and other units. The report illustrates some of the advantages and disadvantages of one method of data collection. As it represents one unit only, care must be taken in extrapolating results to others. The timing of admissions suggests that a review of medical staffing practices would be useful.

Adolescent↗
PubMed1993

Hyperthermia associated with 3,4-methylenedioxyethamphetamine ('Eve').

A patient was admitted with hyperthermia, muscle rigidity, rhabdomyolysis and disseminated intravascular coagulation. He was initially thought to have taken 3,4-methylenedioxymethamphetamine (MDMA, 'Ecstasy'), but subsequent toxicology revealed the presence of 3,4-methylenedioxyethamphetamine (MDEA, 'Eve'), its sister drug, in his blood. Subsequent in vitro testing for malignant hyperthermia proved to be negative.

3,4-Methylenedioxyamphetamine↗
PubMed1992

A clinical evaluation of the 'Rapitrach'. A bedside percutaneous tracheostomy technique.

A number of percutaneous tracheostomy devices are now available commercially. We report a preliminary clinical study of the use of the 'Rapitrach' kit (Fresenius, Runcorn, Cheshire, UK). Twenty critically ill adult patients underwent tracheostomy using the kit. Nineteen of the procedures were carried out at the bedside in the intensive therapy unit. Correct tube placement was achieved in all cases.

Adult↗
PubMed1991

Percutaneous dilational tracheostomy. A bedside procedure on the intensive care unit.

Tracheostomy is performed commonly to aid weaning from assisted ventilation in patients who require intensive care. The procedure carries a significant mortality and morbidity, in part due to problems in moving unstable patients. We report the use of a bedside percutaneous tracheostomy technique for use in adult patients who require intensive care. The procedure was successful in 19 of 20 cases. The one failure, in the first case, resulted from transection of a superficial midline vein. The lack of significant haemorrhage was notable in all other cases. The procedure has proved to be efficient and cost-effective in this unit and has now replaced conventional surgical tracheostomy in this group of patients.

Adult↗
PubMed1991

Midazolam infusions in critically ill patients.

Fifty consecutive patients were studied prospectively to assess the effects of a continuous intravenous infusion of midazolam hydrochloride for sedation in patients requiring intensive care. Patient comfort was acceptable in all patients. However, to maintain the same degree of sedation it was necessary to increase the daily dose of midazolam indicating that benzodiazepine tolerance may have been developing. The time taken to awaken following cessation of a midazolam infusion was prolonged in some patients. In those patients with renal failure the mean (+/- SD) value was 44.6 +/- 42.5 h compared to patients without renal failure in whom it was 13.6 +/- 16.4 h (P less than 0.01). Two patients with combined hepatic and renal failure took 124 and 140 h to awaken. Continuous intravenous infusion of midazolam offers good patient comfort but increasing dose requirements in critically ill patients may lead to drug accumulation and delayed awakening. The risks of cumulation may be increased if the drug is given by continuous infusion for prolonged periods without intermittent assessment of the patient's conscious state.

Adolescent↗
PubMed1990

Plasma concentrations of bupivacaine after intercostal nerve block in patients after orthotopic liver transplantation.

Bilateral intercostal nerve blocks were performed on 12 occasions in 11 patients after liver transplantation. Group 1 (six patients) received bupivacaine 2 mg kg-1 on one occasion; in group 2 (five patients) bupivacaine 2 mg kg-1 with adrenaline 1:200,000 was injected on two occasions separated by 6 h. Arterial blood was sampled repeatedly and analysed for total bupivacaine concentrations by high performance liquid chromatography (HPLC). Six patients had bupivacaine concentrations within the putative toxic threshold of 2-4 micrograms ml-1. The use of adrenaline-containing solutions neither slowed absorption reliably nor decreased peak concentrations of bupivacaine. Cumulation of bupivacaine occurred in group 2. No patient had adverse effects attributable to the bupivacaine.

Adolescent↗
PubMed1990

Anaesthetic hazards of aortocaval fistula.

A 66-yr-old man was anaesthetized for repair of a suspected ruptured aortic aneurysm. He became deeply cyanosed and suffered two episodes of asystole as the surgeons entered the abdomen. After the aorta was cross-clamped his condition improved markedly and no further problems ensued. Surgical exploration demonstrated intact aneurysms of the aorta and left iliac artery, the former containing a 3-4 cm long aortocaval fistula. The aneurysms and fistula were repaired and his further course was uncomplicated. Potential causes for the cyanosis and cardiac arrest in this patient are discussed.

Aged↗
PubMed1990

Reducing the pain of intradermal lignocaine injection by pH buffering.

The effect of pH on the pain of administration and efficacy of 1% lignocaine was investigated in a prospective, double-blind, randomized study of 20 adult volunteers. Onset and spread of anaesthesia by intra-dermal injection were not altered, but there was a significant reduction in pain scores with a higher pH. Overall, pain scores appear to be more dependent on the speed of injection rather than alteration of pH.

Adolescent↗
PubMed1989

Brain stem death and organ donation.

Organs for donation are in short supply in the United Kingdom, resulting in allegations that relatives of potential donors are not being asked for consent. Legislation on "required request" has been proposed to overcome this. The incidence, causes, complications, and patterns of organ donation in brain stem dead patients in one referral centre were studied over 12 months. Data were collected on all patients fulfilling criteria for brain stem death or considered suitable for donating organs after circulatory arrest. Forty two patients fulfilled the criteria for brain stem death, and in 10 further patients circulatory arrest occurred before formal testing was finished. The major causes of brain stem death were head injury (28) and intracranial haemorrhage (17). Consent to organ donation was obtained for 24 potential donors, and organs were donated by 23 of them. Twenty nine patients did not donate organs. The commonest reasons for failure to donate were medical unsuitability (13) and the coroner not releasing the body (eight). Consent was not sought in three cases, and the relatives refused consent in the remaining five. This study suggests that required request will not considerably increase the supply of donor organs.

Adolescent↗
PubMed1989

Care of the multiple organ donor.

Successful organ transplantation offers patients with end stage organ failure the chance of a normal life. The recognition of brain death allowed the use of beating heart donors and this has enabled multiple organ procurement from a single donor. Suitable patients with severe brain injury resulting in brain death, who may be potential organ donors, are to be found on both neurosurgical and general intensive care units. The pathophysiological results of brain death are similar, irrespective of the underlying cause. Severe brain injury may result in the loss of temperature regulation, and the development of diabetes insipidus and cardiovascular instability. The management of brain injury before death often results in abnormalities of fluid balance, due to fluid restriction and diuretic therapy. Other problems such as acute endocrine failure and the impact of their correction on ultimate organ function remains to be elucidated. Good donor maintenance in the intensive care unit and operating theatre is essential if optimal function of the transplanted organ is to occur.

Brain Death↗
PubMed1989

Extrahepatic morphine metabolism in man during the anhepatic phase of orthotopic liver transplantation.

The primary site for the metabolism of morphine has been the subject of controversy for some time. We studied morphine metabolism during the anhepatic phase of orthotopic liver transplantation in seven adult patients. After injection of morphine 10 mg at the beginning of this phase, the plasma and urinary concentrations of unchanged morphine, morphine-3-glucuronide, morphine-6-glucuronide and normorphine were measured by high pressure liquid chromatography. Small but measurable concentrations of morphine metabolites were found in the plasma and urine whilst there was no functional liver tissue in the body. Morphine metabolism increased markedly when the new donor liver was reperfused. This suggests that, in these patients, the liver is the primary site for metabolism of morphine.

Adult↗
PubMed1989

Reversal of prolonged sedation using flumazenil in critically ill patients.

Thirteen critically ill patients received flumazenil after multiple doses, or an infusion, of midazolam was used as part of a sedation regimen to facilitate intensive care. All patients remained excessively sedated after the midazolam was stopped for 6 hours or longer. An improvement in conscious level occurred in eight patients (61%). In four of these eight patients, the duration of action of flumazenil necessitated its continued administration by an infusion to maintain the improvement in conscious level. The dose of flumazenil required each hour was less than estimated previously; this indicates that it may be subjected to similar alterations of elimination as those described for midazolam. Flumazenil appears to be a useful drug for the reversal of prolonged benzodiazepine sedation but repeated bolus doses or an infusion are needed if significant accumulation of benzodiazepines has occurred.

Aged↗
PubMed1988

Reversal of sedation by prolonged infusion of flumazenil (Anexate, Ro 15-1788).

A 22-year-old male was involved in a road traffic accident and sustained multiple injuries. He received an infusion of midazolam to sedate him during a period of artificial ventilation. His conscious level remained depressed 36 hours after the infusion was discontinued but the sedation was completely reversed with flumazenil. An infusion was started because of the short duration of action of flumazenil, and continued for 8 days. The infusion was stopped seven times during this period and on each occasion except the last, his conscious level deteriorated but returned to normal when flumazenil was administered again. Plasma concentrations of midazolam and alpha-hydroxymidazolam were measured and found to be low during this period. Possible explanations for this finding are discussed.

Adult↗
PubMed1988

The altered pharmacokinetics and pharmacodynamics of drugs commonly used in critically ill patients.

The critically ill patient occupies an increasing amount of time and bed space in modern hospital practice, and also commands increasing expenditure. Drug therapy in these patients has, in the past, been based on data derived from healthy volunteers, fit anaesthetised patients undergoing minor operative procedures, or patients with single organ failure. Alterations in pharmacokinetics and pharmacodynamics have not been studied in depth in critically ill patients who often have multisystem failure. This paper reviews the currently available information on drugs in common usage in these patients. The studies that have been performed have usually shown delayed drug clearance, altered volumes of distribution and prolonged elimination half-lives. The sedative and analgesic drugs, in particular, have shown marked accumulation which may confuse the clinical picture, and prolonged periods of assisted ventilation may be required until the drugs are eliminated.

Critical Care↗