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Biomedical subjects

A J Mellor

Publications and source records attributed to A J Mellor.

5 recordsLinked to original sources
PubMed2005

Anaesthesia in austere environments.

The scope of this review is by necessity somewhat limited and, as said in the introduction, methods used will depend on the skills and experience of the practitioner involved. The triservice apparatus remains the system of choice for delivering volatile anaesthetic agents to patients in areas without the infrastructure to supply an endless quantity of medical gases, the planned isolated or battle conditions of Boultons scenarios. The TSA's portability, robust design and versatility have stood the test of time. By reviewing intravenous agents the author has attempted to find an evidence base for the most appropriate agent for a non anaesthetic trained doctor finding his or herself called on to provide emergency anaesthesia in the field. The most useful drug is ketamine which has the advantage of cardiovascular stability, preservation of airway reflexes, ease of administration via different routes and versatility for providing analgesia, sedation or general anaesthesia.

Anesthesia↗
PubMed2001

Vasodilator pre-treatment of human radial arteries; comparison of effects of phenoxybenzamine vs papaverine on norepinephrine-induced contraction in vitro.

AIMS: The radial artery, increasingly used for coronary artery bypass grafting (CABG). has a potential for spasm which may increase peri-operative risk. Increased alpha-adrenoceptor activation is a key candidate for the spasm. We studied the effects of vasoconstriction in a radial artery, which had undergone brief exposure to the alpha-adrenoceptor antagonist phenoxybenzamine vs the opioid derivative papaverine. METHODS AND RESULTS: Using standard classical organ bath techniques, concentration responses were obtained to norepinephrine in segments of radial artery from 12 CABG patients pre- and post-incubation for 20 min in either phenoxybenzamine 10(-6) M or papaverine 3 x 10(-3) M. Responses were reassessed 2, 4 and 18 h after washout of phenoxybenzamine and 2, 4, 8 and 18 h after washout of papaverine. There was concentration-dependent constriction to norepinephrine (maximum response 0.89 +/- 0.20 (SEM) g x mm(-1), n=6). Constriction to norepinephrine was abolished immediately after incubation in phenoxybenzamine and remained completely inhibited for at least 18 h (P<0.0001 ANOVA phenoxybenzamine pre-treated vs controls). Most of the inhibition of concentration-dependent constriction to norepinephrine following pre-treatment with papaverine was lost 8 h later. CONCLUSION: Radial artery vasoconstriction induced by a clinically relevant agonist, norepinephrine, may be prevented for at least 18 h by pre-incubation in phenoxybenzamine, in contrast to the brief inhibition achieved by pre-treatment with papaverine. Adding phenoxybenzamine to radial artery graft bathing solution may improve early outcome following CABG.

Aged↗
PubMed2000

Helicopter medical retrieval in Sydney, New South Wales.

Undoubtedly the main attraction of this job is the interest of never knowing what will happen next! Primary response to an MVA allows one to experience the atmosphere and deal with clinical situations in an alien setting. This broadens ones perspective and has taught me never to be tempted to criticise a paramedic bringing a patient into a resus room. The same is true of interhospital transfers where tact and diplomacy can be tested as well as clinical skills. On the negative side the unpredictability can be difficult domestically (a primary at 17555 means you will be at least two hours late home) and there can be long and dull days when nothing happens. A lot of time is spent transporting post arrest patients from one hospital to another to find an ICU bed. In military medicine it is difficult to envisage a future conflict when severely injured casualties would not require transport both locally and over long distances. This job provides an ideal opportunity to become confident with transporting critically ill patients.

Air Ambulances↗