Transtracheal ventilation.
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Airway Obstruction↗
Biomedical subjects
A C Pearce
Publications and source records attributed to A C Pearce.
Evaluation of the Upsherscope. A new rigid fibrescope.
A new, rigid intubating fibrescope, the Upsherscope, was evaluated in clinical practice. Intubation was attempted in 200 adult patients and was successful in 191, with a median intubation time of 38 s, range 14-154 s. Intubation was straightforward in just under half of the patients. Difficulties were encountered in picking up the epiglottis, in passing the tracheal tube between the vocal cords and with secretions interfering with the view. In two patients known to be difficult to intubate, the Upsherscope was successful in one patient using an awake technique and failed in the other.
Adolescent↗
Percutaneous balloon pericardiotomy for the treatment of cardiac tamponade and large pericardial effusions: description of technique and report of the first 50 cases.
OBJECTIVES: This study describes the technique, clinical characteristics and results of the first 50 patients undergoing percutaneous balloon pericardiotomy as part of a multicenter registry. BACKGROUND: Percutaneous balloon pericardiotomy involves the use of a percutaneous balloon dilating catheter to create a nonsurgical pericardial window. METHODS: Patients eligible for percutaneous balloon pericardiotomy had either cardiac tamponade (n = 36) or a moderate to large pericardial effusion (n = 14). In addition to clinical follow-up, serial echocardiograms and chest X-ray films were obtained. RESULTS: The procedure was considered successful in 46 patients after a mean follow-up period of 3.6 +/- 3.3 months. Two patients required an early operation, one for bleeding from a pericardial vessel and one for persistent pericardial catheter drainage. Two patients required a late operation for recurrent tamponade. Minor complications of the procedure included fever in 6 of the first 37 patients (studied before the prophylactic use of antibiotic agents), thoracentesis or chest tube placement in 8 and a small spontaneously resolving pneumothorax in 2. Despite the short-term success of this procedure, the long-term prognosis of the 44 patients with malignant pericardial disease remained poor (mean survival time 3.3 +/- 3.1 months). CONCLUSIONS: Percutaneous balloon pericardiotomy is successful in helping to manage large pericardial effusions, particularly in patients with a malignant condition. It may become the preferred treatment to avoid a more invasive procedure for patients with pericardial effusion and a limited life expectancy.
Aged↗
Fibreoptic intubation. Influence of tracheal tube tip design.
A randomised study was carried out in 60 patients to assess the influence of tracheal tube tip design on the ease of railroading a tracheal tube during fibreoptic intubation. A new design of tracheal tube with a tapered tip, without a bevel, was compared with a tracheal tube of standard design. The new design was found to be greatly superior in both oro- and nasotracheal fibreoptic intubation, when compared with the traditional tracheal tube (p < 0.001). The shape of the tip of a tracheal tube is an important determinant of the ease of railroading the tube over an inserted fibrescope.
Adult↗
Antegrade selective coronary angiography via the transseptal approach in a patient with severe vascular disease.
We describe a case of a woman with severe vascular disease in whom retrograde access to the aortic root was limited by both aortoiliac and axillary disease. Transseptal catheterization was performed in anticipation of percutaneous aortic valvuloplasty. Selective antegrade angiography was successfully performed using catheters introduced through the transseptal sheath.
Aged↗
Assessment of a new nasopharyngeal airway.
A new design of nasopharyngeal airway, which incorporates an introducer, was compared with a standard red rubber airway. The new airway was more frequently of the correct length, but the incidence of bleeding (12.5%) was not significantly different from that with the red rubber airway (27.5%).
Adolescent↗
Fade profiles during spontaneous offset of neuromuscular blockade: vecuronium and gallamine compared.
The characteristics of the train-of-four (TOF) response have been studied electromyographically during the onset and the spontaneous offset of neuromuscular blockade induced with vecuronium or gallamine. During the onset of blockade, at 75% depression of initial twitch height, gallamine was associated with significantly more TOF fade than vecuronium. Both agents were associated with significantly less fade during onset than during spontaneous offset. When the two neuromuscular blocking drugs were compared during spontaneous offset they showed a similar degree of fade during early offset (up to 50% recovery of initial twitch height). However, during late spontaneous offset, when the initial twitch height had recovered to 75% of control values, vecuronium was associated with more fade than gallamine.
Adult↗
Factors affecting train-of-four fade.
The characteristics of the train-of-four response during neuromuscular blockade with two agents, atracurium and vecuronium, have been compared. During onset of blockade, at 75% depression of the initial twitch, atracurium was associated with significantly more fade than was vecuronium, and larger doses of atracurium were associated with less fade than smaller doses of the same agent. In addition, with both agents, the degree of fade at a given amount of initial twitch depression was significantly less during onset than during spontaneous offset of action. The degree of train-of-four fade bears no fixed relationship to depression of the initial twitch.
Adult↗
Recovery characteristics following antagonism of atracurium with neostigmine or edrophonium.
The evoked reversal characteristics of atracurium were studied in 21 patients using edrophonium or neostigmine and a train-of-four pattern of stimulation. Reversal of residual atracurium -induced neuromuscular blockade was significantly more rapid using edrophonium compared with neostigmine. The ratio of the fourth twitch in the train-of-four to the first twitch--the T4 ratio--was significantly greater when the first twitch (T1) had recovered to 75% of control T1, using edrophonium compared with neostigmine. A T4 ratio of 0.5 was confirmed to be compatible with the reliable and safe reversal of atracurium -induced neuromuscular blockade.
Adult↗
Atracurium for short surgical procedures in day patients.
Atracurium was studied in day-stay patients undergoing short surgical procedures requiring tracheal intubation. In a dose of 0.25 mg kg-1 and with an anaesthetic technique using enflurane, tracheal intubation could be performed in all patients within 3 min and was readily reversible, unless the duration of surgery was less than 20 min. The administration of an antagonist was indicated in nearly all patients in whom surgery lasted for less than 30 min.
Adult↗
Smoking and anesthesia: preoperative abstinence and perioperative morbidity.
Much less is known of the effects of stopping smoking than of continuing to smoke, and many of the studies on smoking cessation are concerned with long-term effects rather than effects within 48 hr. Studies concerned with this period are required, especially in terms of postoperative respiratory morbidity, before an authoritative assessment can be made of the benefits and risks of stopping smoking in the short period before operation. Present studies are convincing that great benefit will accrue in the cardiovascular system, mainly from carbon monoxide and nicotine elimination, after 12-24 h. A few days may greatly improve ciliary beating and 1-2 weeks provide a significant reduction in sputum volume. However, a minimum period of 4-6 weeks would seem appropriate to greatly influence postoperative respiratory morbidity, although the statement that "one needs 4-6 weeks to influence postoperative respiratory morbidity" must not be misapplied and become "there is no point in giving up smoking unless it is 4-6 weeks prior to operation." There are no proven disadvantages to the respiratory system from stopping smoking in the short term, and it seems unwise to sacrifice proven advantages for a theoretic consideration that sputum may become "stickier" and more difficult to clear. Less is known with regard to the time course of offset of smoking effects on drug metabolism and the immune system, although 6-8 weeks would be expected to produce some benefit.(ABSTRACT TRUNCATED AT 250 WORDS)
Analgesics↗
Pre- and postjunctional effects of neuromuscular blocking agents and their antagonists.
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Cholinesterase Inhibitors↗