PubMed Health⌕ Search

Biomedical subjects

A J Coe

Publications and source records attributed to A J Coe.

13 recordsLinked to original sources
PubMed2006

Expired gas backflow in oxygen delivery tubing.

Using capnography, we investigated the backflow of expired gas into oxygen delivery tubing in 18 sedated patients receiving supplementary oxygen via a disposable facemask during spinal anaesthesia. At 5 cm from the mask, with an oxygen flow of 2 l.min(-1), carbon dioxide was detected in the oxygen delivery tubing of three patients (18%) on coughing. With the patient wearing the facemask but the oxygen tubing disconnected from the oxygen source, carbon dioxide was detectable 1 m from the facemask (i.e. at the fresh gas outlet) in 14 patients. In a second group of 20 similar patients, no carbon dioxide was detected sampling at the fresh gas outlet with flows of 2 and 4 l.min(-1). Assuming that detection of carbon dioxide indicates at least the possibility of contamination, oxygen tubing should be strictly single-use in this setting. Our findings suggest that filters are not required to protect gas supply outlets, provided that the patient's facemask is removed when the fresh gas outlet is disconnected.

Adult↗
PubMed2004

The management of patients with morbid obesity in the anaesthetic assessment clinic.

One hundred and two patients with body mass indices of 37 kg x m(-2) or greater were interviewed in an outpatient assessment clinic over an 18-month period. All had been listed for elective surgery under general anaesthesia. All patients were given an explanation of the problems of morbid obesity in relation to anaesthesia. Three options were then offered to the patients: 1) to proceed with general anaesthesia as planned; 2) to undergo the planned procedure under some form of regional anaesthesia, or 3) to postpone surgery and attempt to lose significant amounts of weight. At this initial consultation, 24 patients chose option 1, 21 patients chose option 2, and 52 patients chose option 3. Four patients decided not to have the planned surgery. One patient decided to have his surgery performed at another hospital under general anaesthesia. Of the 52 patients who opted to lose weight, only eight succeeded in reducing their body mass index (BMI) by 3 or more during the period of the study. Of these eight, only four had reduced their BMI to below 35. In this study, an explanation of the problems of obesity in relation to anaesthesia, in advance of the date of surgery, had a significant effect on the type of anaesthesia chosen by most morbidly obese patients that were interviewed. Unfortunately, of those who decided to try and lose weight, only the occasional patient achieved significant weight loss. Although a laudable and advocated aim, optimization of patients with regard to their weight proved impractical in our study.

Adult↗
PubMed2001

False-positive epidural catheter aspiration tests in needle through needle combined spinal-epidural anaesthesia.

We describe two separate episodes of free aspiration of clear fluid through epidural catheters during needle-through-needle combined spinal-epidural anaesthesia in the lateral position. Although both catheters were assumed to have been located intrathecally, both subsequently gave negative test doses and were used as epidural catheters. In the second patient, the position of the catheter was investigated using contrast spiral computerised tomography scanning, which showed epidural contrast spread only. This is the first time such an occurrence has been recognised, and we consider its significance for catheter site confirmation testing in combined spinal-epidural anaesthesia.

Aged↗
PubMed1996

Perinatal mortality in lambs in southern Brazil.

Hypothermia and dystocia were found to be the most common causes of perinatal mortality in 8 commercial wool flocks in one region of southern Brazil. It was established that low birth weight and poor maternal instinct in the ewes predisposed to losses due to hypothermia but that there appeared to be no association with adverse weather conditions. Other factors possibly predisposing to losses are discussed.

Animals↗
PubMed1990

Is crystalloid preloading useful in spinal anaesthesia in the elderly?

Sixty ASA grade 1 or 2 patients, aged 60 years or over, scheduled for surgery to the lower abdomen or lower limbs under spinal anaesthesia were allocated randomly to one of three treatment groups. Group A received 16 ml/kg of Ringer's acetate solution immediately before spinal anaesthesia, group B received 8 ml/kg and group C received no volume preload. Heart rate, arterial pressure and anaesthetic level were recorded by an independent observer. The overall incidence of systemic arterial hypotension (defined as a decrease of 25% or more in systolic arterial pressure) was 27%; there were no significant differences among groups. The overall incidence of hypotension was 60%, when temperature sensation was blocked to T7 and above (n = 25). The number of patients with hypotension which required treatment increased as block height increased above T7; at a level of T4 or higher, all patients required ephedrine. Crystalloid preloading had no effect on the incidence of hypotension after spinal anaesthesia in fit, elderly patients.

Aged↗
PubMed1988

Alkalinized bupivacaine and adrenaline for epidural caesarean section. A comparison with 0.5% bupivacaine.

Twenty-four mothers received either 0.5% bupivacaine (group 1, n = 14), or alkalinized 0.5% bupivacaine and 1 in 200,000 adrenaline (group 2, n = 10), as an epidural local anaesthetic for elective lower segment Caesarean section in a randomised, double blind study. The two groups were prepared for surgery according to an identical technique. Onset of analgesia to pinprick was significantly faster in group 2 (p less than 0.02). Group 1 required additional analgesia during surgery significantly more often than those in group 2 (p = 0.04). Significantly more patients in group 2 were ready for surgery by the time limit for the study (45 minutes, p = 0.002). Onset of motor blockade was significantly faster in group 2 (p = 0.01). There were no significant differences between the two groups with regard to duration of surgery, or Apgar scores at 1 and 5 minutes. Alkalinized 0.5% bupivacaine and adrenaline was superior to 0.5% bupivacaine for epidural Caesarean section.

Anesthesia, Epidural↗
PubMed1988

Triple-lumen catheters.

Triple-lumen intravenous catheters have been available in the UK for 5 years. They are very useful for simultaneous monitoring and multiple infusion therapy. They are not difficult to insert using standard techniques and their use will probably increase. At the moment there are seven products on the British market, with a range of lumen sizes, special features and prices.

Catheterization, Central Venous↗