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Biomedical subjects

A D MacLeod

Publications and source records attributed to A D MacLeod.

10 recordsLinked to original sources
PubMed2006

A Scottish National Prospective Study of airway management skills in new-start SHOs.

BACKGROUND: There is increasing concern about the ability of junior anaesthetists to manage the airway correctly and alarm that this may lead to adverse events. METHODS: We monitored the airway management skills of new-start anaesthetists in Scotland for 3 months. RESULTS: Experience with the laryngeal mask airway was satisfactory but there was wide variation in numbers of facemask and tracheal intubation cases. CONCLUSIONS: We recommend that facemask anaesthesia is given a high priority in the formative months and that a target number of intubations should be carried out before providing anaesthesia without direct supervision.

Anesthesiology↗
PubMed1990

Inhaled fentanyl as a method of analgesia.

A study was undertaken to investigate the use of fentanyl by aerosol for postoperative analgesia. Seven patients had placebo, six received fentanyl 100 micrograms and seven were given fentanyl 300 micrograms. A significant improvement in postoperative pain, as assessed by linear visual analogue scale, was achieved in the higher dose group, and in both fentanyl groups the time to alternative analgesia was significantly longer than in the control group. Serum fentanyl levels after inhalation of 100 micrograms reached a plateau around 0.04 ng/ml and after 300 micrograms at around 0.1 ng/ml after 15 minutes. Inhaled fentanyl may have a useful analgesic effect despite these low serum levels; this supports the hypothesis that the mode of analgesia from inhaled opioids may be different from that after other routes of administration. There were no adverse effects such as respiratory depression, bronchospasm, nausea or drowsiness.

Adolescent↗
PubMed1989

Automatic control of neuromuscular block with atracurium.

We have developed and tested a system for providing automatic control of neuromuscular block with atracurium. The degree of neuromuscular block was monitored in the small muscles of the hand using a Datex Relaxograph, and the signal was used as the controlled variable for a proportional plus integral controller. A preloaded integral was used to shorten the period of stabilization. The system was tested in 36 patients undergoing surgery and found to produce stable block. For a target T1 of 20% of control value, the mean block was 18.7 (SD 1.3) % of baseline T1 and the mean consumption of atracurium was 5.39 (SD 1.23) micrograms kg-1 min-1. The block was sufficiently stable to act as a background for studies of pharmacological and physiological interactions with atracurium.

Adult↗
PubMed1986

Anaphylactoid reaction complicating neonatal anaesthesia.

A three-week-old girl presented for surgery for congenital pyloric stenosis. The anaesthetic technique included intravenous induction with thiopentone and neuromuscular blockade with atracurium. The administration of these drugs was followed within 2-3 minutes by oedema of the eyelids and epiglottis, reduced peripheral circulation and central cyanosis. There was no previous exposure to either drug and no definite family history of allergy. Analysis of subsequent sequential blood samples indicated that the reaction mechanism was non-immune and was presumed to be due to pharmacological release of histamine.

Anaphylaxis↗
PubMed1976

Prolonged eradication of urogenital mycoplasmas after administration of tetracycline to men in the Antarctic.

Meatal swabs were obtained at intervals over 1 year from 23 men in the Antarctic. A 5-day course of tetracycline was given to twelve of them. In retrospect it was found that the antibiotic had been received by two men who were harbouring ureaplasmas, one of whom also had M. hominis. After treatment, these organisms were not found in any of the swabs taken over the next year, except in a swab from one of the men following sexual contact after this time. One of the twelve men developed N.S.U. just before arriving in the Antarctic. He responded clinically to a shorter course of tetracycline and ureplasmas were not recovered from a meatal swab immediately thereafter. However, without further sexual contact, ureaplasmas and disease recurred about a month later. This time, after a 5-day course of tetracycline, disease was not seen, and ureaplasmas were not isolated, over the next year. In contrast, ureaplasmas were isolated consistently over a year from two men who were not given the antibiotic. The evidence strongly suggests that, under natural conditions, the most likely cause of mycoplasmas, particularly ureaplasmas, recurring in the genital tract after apparently adequate tetracycline therapy, is re-infection as a result of sexual re-exposure.

Antarctic Regions↗
PubMedDate not supplied

Hemodynamic and respiratory effects of transtracheal high-frequency jet ventilation during difficult intubation.

STUDY OBJECTIVE: To evaluate the hemodynamic and respiratory effects of percutaneous transtracheal high-frequency jet ventilation (HFJV) during difficult intubation using fiberoptic bronchoscopy under general anesthesia. DESIGN: Prospective study. SETTING: Surgical patients scheduled for general anesthesia at the Medical College of Virginia Hospital. PATIENTS: Eight patients with known difficult airways. Three patients had deformed facial structures. One patient had temporomandibular joint impairment. Four patients had tumors of the oral cavity with deformed upper airways. INTERVENTIONS: A 13-gauge cricothyroidotomy jet ventilation cannula was inserted percutaneously under local anesthesia. Anesthesia was induced with etomidate 0.2 to 0.3 mg/kg, alfentanil 15 to 20 micrograms/kg, and vecuronium 0.1 mg/kg. HFJV was started with 100% oxygen at 30 to 35 pounds per square inch of driving pressure, 100 cycles per minute, and an inspiratory/expiratory ratio of 25%. Thoracic electrical bioimpedance was used to measure cardiac index (CI) and ejection fraction (EF). MEASUREMENTS AND MAIN RESULTS: Mean arterial pressure (MAP), heart rate (HR), CI, and EF were measured before induction of anesthesia; after 1 minute of HFJV, 5 minutes of HFJV, and 10 minutes of HFJV; and during positive pressure ventilation following fiberoptic intubation. Arterial blood gas samples were obtained before induction of anesthesia and after 10 minutes of HFJV. HR decreased significantly after 5 minutes of HFJV, after 10 minutes of HFJV, and after intubation (p less than 0.05). MAP decreased significantly after 10 minutes of HFJV compared with the preinduction value (mean, 97 to 71 mmHg; p less than 0.01). Although EF increased significantly following intubation, from 46% to 59%, there were no significant changes in CI. Arterial oxygen tension increased from 85 to 240 mmHg (p less than 0.05). Arterial carbon dioxide tension also increased, from 39 to 42 mmHg (p less than 0.05). CONCLUSIONS: Transtracheal HFJV under general anesthesia with etomidate, alfentanil, and vecuronium provided satisfactory hemodynamic conditions and pulmonary gas exchange. Percutaneous transtracheal HFJV can be used safely to manage patients with a difficult airway under general anesthesia using fiberoptic bronchoscopy.

Anesthesia, Intravenous↗