Biomedical subjects
Publications and source records attributed to A E Delilkan.
Spinal anaesthesia was performed on 101 patients with a 25-Gauge (0.52 mm) needle. We found a 13.9% overall incidence of postdural puncture headache (PDPH) in an orthopaedic population whose mean age was 33.6 years. This incidence is too high and an alternative technique may be needed.
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Tracheal tears are not as uncommon as initially thought. The resultant insufficiency and hypoxia can be life-threatening. The keystone in management is early recognition and diagnosis. Immediate surgical repair is essential.
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The 'Priming principle' applied to non-depolarizing muscle relaxant atracurium was studied in 60 patients. This was a double blind study. The conditions observed for intubation were graded and the efficacy of priming dose of atracurium for shortening the onset time of intubation was studied. The patients were of ASA classification I and II and received standard premedication. The purpose of the study was to use the priming dose of atracurium to shorten the onset time of intubating dose of atracurium. This would be desirable in conditions requiring rapid intubation and in situations when the depolarizing muscle relaxant suxamethonium is contra-indicated. The results were statistically significant.
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Topic adrenaline with cocaine has been used commonly for intranasal vasoconstriction to facilitate surgery and to control haemorrhage. Pharmacologically the drug combination is known to be a potentially dangerous interaction. This investigation studied whether either drug could be used separately rather than in combination, to achieve the same purposes. One hundred cases were randomized into four groups using 1:1000 Adrenaline, 5% Cocaine, 10% Cocaine and 5% Cocaine/1:1000 Adrenaline as the topical vasoconstriction regimes. The results showed that the vasoconstrictor effect was not significantly different within the four groups; topical 1:1000 Adrenaline resulted in more haemorrhage compared to the other three regimes; comparing the other three regimes the blood loss was not significantly different. The conclusion is that the Adrenaline/Cocaine mixture has no advantage and its potentially dangerous interaction makes it unnecessary and unjustified. Topical 5% Cocaine is recommended because it achieves the aims with the least side-effects.
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Patients with extensive skin-grafting of the head and neck are managed for the first 24-48 hours postoperatively in the Intensive Care Unit with muscle paralysis, controlled ventilation, timed parenteral analgesia and sedation. The aims are to provide full immobilization of the graft and to allow pressure dressings without embarrassment to the airway. The regime is suggested as an added indication for intensive care therapy.
The anaesthetic management for surgical procedures involving the larynx and/or trachea and the problem of the shared airway are outlined. The use of intravenous Althesin on 31 patients (43 administrations) is described. It is suggested that Althesin has a place in the management of these patients.
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