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Biomedical subjects

A R Bodenham

Publications and source records attributed to A R Bodenham.

At least 19 recordsLinked to original sources
PubMed2003

Disorders of the lymph circulation: their relevance to anaesthesia and intensive care.

The lymphatic system is known to perform three major functions in the body: drainage of excess interstitial fluid and proteins back to the systemic circulation; regulation of immune responses by both cellular and humoral mechanisms; and absorption of lipids from the intestine. Lymphatic disorders are seen following malignancy, congenital malformations, thoracic and abdominal surgery, trauma, and infectious diseases. They can occasionally cause mortality, and frequently morbidity and cosmetic disfiguration. Many lymphatic disorders are encountered in the operating theatre and critical care settings. Disorders of the lymphatic circulation relevant to anaesthesia and intensive care medicine are discussed in this review.

Anesthesia↗
PubMed1999

Urine colour as an index of hydration in critically ill patients.

In order to test the hypothesis that urine colour can be used as an index of hydration in critically ill patients, we selected 40 intensive care and high-dependency patients and correlated urine colour (scored on an eight-point scale) with various indices of hydration: urine:plasma sodium, osmolality and urea ratios, urine output and central venous pressure. In addition, we compared the colour-chart score with scores made by intensive care nurses (without the benefit of a colour chart) in order to test subjective assessment of urine colour. There were weak but statistically significant correlations between urine colour and urine output (Spearman's r = - 0.555) and between urine colour and urine:plasma sodium ratio (Spearman's r = - 0.459). Subjective assessment of urine colour appeared to be reliable. Thus, although urine colour does vary with hydration in the critically ill, assessment of urine colour adds little to the overall assessment of hydration in this group of patients.

Adolescent↗
PubMed1999

Carotid endarterectomy under local anaesthesia.

Carotid endarterectomy has been widely used for the surgical treatment of carotid stenosis, and may be performed under either general or local anaesthesia. This article examines the relative merits of both techniques for carotid endarterectomy, and describes the local anaesthetic technique used by the authors for this procedure.

Anesthesia, General↗
PubMed1998

Use of the Combitube for airway maintenance during percutaneous dilatational tracheostomy.

The Combitube airway allows short-term ventilation during cardiopulmonary resuscitation and can be useful in the management of the difficult airway. In a prospective observational study we assessed its use during percutaneous dilatational tracheostomy (PDT). Twenty-one intensive care patients scheduled for elective PDT had their tracheal tube replaced by a Combitube airway retaining the same ventilator settings. Arterial blood gases, airway pressures, SpO2 and end-tidal CO2 were measured as were the transmural pressures exerted by the Combitube cuffs. Combitube placement was successful in 20 of 21 patients although adequate ventilation was possible in only 17 (85%). There was no significant change in PaO2, SpO2, end-tidal CO2, Paco2 or mean airway pressure during Combitube ventilation. A high mean (SD) transmural pressure of 14.7 (5) kPa was exerted by the distal cuff. The Combitube provided a satisfactory alternative airway to the tracheal tube during performance of PDT in 85% of our patients. Potential problems associated with its use in intensive care patients are outlined.

Dilatation↗
PubMed1998

Peribulbar anaesthesia using a mixture of local anaesthetic and vecuronium.

The aim of this double-blind, randomised study was to assess the effects of the addition of 0.5 mg of vecuronium bromide to a standard local anaesthetic mixture used for peribulbar anaesthesia. We studied 60 patients undergoing regional anaesthesia for intra-ocular surgery and were primarily interested in the quality of globe and lid akinesia. All received a mixture of 5 ml 2% lignocaine with 1:200,000 adrenaline, 5 ml 0.75% bupivacaine and 150 IU hyaluronidase with either 0.9% saline 0.25 ml (group A, n = 30) or vecuronium bromide 0.25 ml (0.5 mg) (group B, n = 30). Eye movements assessed at both 5 and 10 min were significantly reduced in the vecuronium group (group B) (p < 0.05). We conclude that the addition of vecuronium at a dose of 0.5 mg to the standard local anaesthetic mixture improves the quality of globe and lid akinesia.

Aged↗
PubMed1997

A review of the management of abdominal aortic aneurysms in patients following cardiac transplantation.

OBJECTIVES: To describe the presentation, preoperative assessment and postoperative management of patients presenting with an infrarenal abdominal aortic aneurysm following a previous cardiac transplant. METHODS: The case histories of three patients have been examined and a literature review performed. CONCLUSIONS: The majority of patients developing aortic aneurysms had undergone cardiac transplantation for ischaemic cardiomyopathy and thus require detailed assessment of cardiac function preoperatively to exclude accelerated coronary artery disease in the graft. Full invasive cardiac monitoring during surgery is mandatory to maintain haemodynamic stability in patients with a dennervated heart and to avoid postoperative renal failure. The higher incidence of pulmonary and wound complications are discussed, together with protocols for maintaining adequate immunosuppression. Finally, data supporting a higher prevalence and more rapid expansion of aortic aneurysms in immunosuppressed patients is considered and evidence-based recommendations made regarding aneurysm screening in these patients.

Adult↗
PubMed1997

Initial evaluation of diaspirin cross-linked hemoglobin (DCLHb) as a vasopressor in critically ill patients.

OBJECTIVE: To evaluate the hemodynamic effects and any toxicologic effects of diaspirin cross-linked hemoglobin (DCLHb) in critically ill patients. DESIGN: A prospective, observational study. SETTING: A seven-bed intensive care unit (ICU) in a University teaching hospital. PATIENTS: Fourteen critically ill patients requiring vasopressor therapy to maintain adequate mean arterial pressure (MAP). All patients had secondary organ dysfunction. INTERVENTIONS: Administration of 100 mL boluses of 10% diaspirin cross-linked hemoglobin, up to a maximum of 500 mL, given over 15 mins and separated by 60 to 90 mins. MEASUREMENTS AND MAIN RESULTS: Hemodynamic parameters, norepinephrine and inotropic requirements, arterial and mixed venous blood gases, urine output, and biochemical and hematologic analyses were measured before diaspirin cross-linked hemoglobin administration and at multiple time points up to 72 hrs. MAP was maintained at approximately preinfusion values and the reduction in norepinephrine requirements was used as the main end point to assess the efficacy of diaspirin cross-linked hemoglobin as a vasopressor. Diaspirin cross-linked hemoglobin demonstrated a marked vasopressor action, allowing norepinephrine requirements to be reduced from 0.29 +/- 0.15 (SD) microgram/kg/min to 0.15 +/- 0.14 and 0.07 +/- 0.10 microgram/kg/min after the first (at 1.5 hrs, p < .001) and last (at 7.5 hrs, p < .0001) boluses, respectively. These reductions in norepinephrine requirements were maintained at 24, 48, and 72 hrs (p < .01 at all time points). These hemodynamic changes began within 5 mins of starting the diaspirin cross-linked hemoglobin infusion. MAP, heart rate, central venous pressure, pulmonary artery occlusion pressure, mean pulmonary arterial pressure (MPAP), systemic vascular resistance index, and urine output did not demonstrate any significant changes from preinfusion values. Pulmonary vascular resistance index increased at 7.5 hrs despite nonsignificant increases in MPAP. Cardiac index and oxygen delivery index decreased significantly at 7.5 hrs and 24 hrs. Total plasma bilirubin increased significantly from baseline at 24 and 48 hrs, before returning to baseline values within 5 days. Platelet count was significantly reduced at 6 and 24 hrs. No other biochemical or hematologic analyses were altered significantly post diaspirin cross-linked hemoglobin. CONCLUSIONS: This preliminary study demonstrated that diaspirin cross-linked hemoglobin is a potent vasopressor agent in critically ill patients with septicemic shock or systemic inflammatory response syndrome. This vasopressor characteristic of diaspirin cross-linked hemoglobin may have future clinical applications.

Adult↗
PubMed1997

MDMA induced hyperthermia: a survivor with an initial body temperature of 42.9 degrees C.

A young male survived hyperpyrexia (42.9 degrees C) following MDMA ("Ecstasy") ingestion. He developed convulsions, rhabdomyolysis, metabolic acidosis, and respiratory failure. This was successfully managed by assisted ventilation, aggressive fluid therapy, and the early administration of dantrolene, in addition to cooling measures. This is the first report of a survivor with such a severe hyperpyrexia.

Adult↗
PubMed1996

Local anaesthesia to the airway reduces sedation requirements in patients undergoing artificial ventilation.

Patients in the intensive care unit require large doses of sedative/analgesic drugs to tolerate the presence of a tracheal tube and other unpleasant stimuli. The ideal regimen for sedatives and analgesics has not yet been found. We have investigated the effects of topical local anaesthesia to the pharynx and airway on sedative/analgesic requirements in 30 ICU patients (25-75 yr old) with no obvious brain injury, undergoing mechanical ventilation. Oral tracheal tubes were changed to a modified tube which allowed instillation of local anaesthetic solutions onto the pharyngeal, laryngeal and tracheal mucosa. Lignocaine 1% (5 ml) or 5 ml of 0.9% saline were instilled hourly for 12 h each for a total of 24 h, in a double-blind, randomized crossover design. Baseline sedation was maintained with propofol or alfentanil infusions, or both, which were titrated to patient comfort and to maintain an optimum sedation score throughout. Twenty-five patients completed the study. Mean total propofol and alfentanil requirements were 766 (SD 524) mg and 17 (7.6) mg, respectively, during 12 h of lignocaine instillation, and 1321 (862) mg and 25 (11.4) mg, respectively, during 12 h of saline instillation. There was a significant reduction (P < 0.05) in the requirements for both agents during the period of lignocaine instillation.

Adult↗
PubMed1996

Validation of use of whole-cell repetitive extragenic palindromic sequence-based PCR (REP-PCR) for typing strains belonging to the Acinetobacter calcoaceticus-Acinetobacter baumannii complex and application of the method to the investigation of a hospital outbreak.

Acinetobacter spp. are being reported with increasing frequency as causes of nosocomial infection. In order to identify reservoirs of infection as quickly as possible, a rapid typing method that can differentiate epidemic strains from environmental and nonepidemic strains is needed. In 1993, a cluster of Acinetobacter baumannii isolates from five patients in the adult intensive therapy unit of our tertiary-care teaching hospital led us to develop and optimize a rapid repetitive extragenic palindromic sequence-based PCR (REP-PCR) typing protocol for members of the Acinetobacter calcoaceticus-A. baumannii complex that uses boiled colonies and consensus primers aimed at repetitive extragenic palindromic sequences. Four of the five patient isolates gave the same REP-PCR typing pattern as isolates of A. baumannii obtained from the temperature probe of a Bennett humidifier; the fifth isolate had a unique profile. Disinfection of the probe with 70% ethanol, as recommended by the manufacturer, proved ineffective, as A. baumannii with the same REP-PCR pattern was isolated from it 10 days after cleaning, necessitating a change in our decontamination procedure. Results obtained with REP-PCR were subsequently confirmed by ribotyping. To evaluate the discriminatory power (D) of REP-PCR for typing members of the A. calcoaceticus-A. baumannii complex, compared with that of ribotyping, we have applied both methods to a collection of 85 strains that included representatives of six DNA groups within the complex. Ribotyping using EcoRI digests yielded 53 patterns (D = 0.98), whereas 68 different REP-PCR patterns were observed (D = 0.99). By computer-assisted analysis of gel images, 74 patterns were observed with REP-PCR (D = 1.0). Overall, REP-PCR typing proved to be slightly more discriminatory than ribotyping. Our results indicate that REP-PCR typing used boiled colonies is a simple, rapid, and effective means of typing members of the A. calcoaceticus-A. baumannii complex.

Acinetobacter↗
PubMed1995

An evaluation of a new percutaneous tracheostomy kit.

The Portex percutaneous trachestomy kit incorporates guidewire dilating forceps which pass over a guidewire and perform rapid dilatation. These forceps have curved jaws which are designed to reduce possible damage to the lateral and posterior walls of the trachea. The guidewire dilating forceps are first opened in front of the trachea to dilate the pretracheal tissues and then opened in the trachea to dilate the anterior tracheal wall. A tracheostomy tube is then passed over the guidewire and into the trachea. The procedure was rapid and successful in all 20 patients, with no serious complications. Mean time to perform tracheostomy was 4.9 min (range 90 s-15 min). Overall, the Portex percutaneous tracheostomy kit worked well and proved a rapid and acceptable method for performing percutaneous tracheostomy.

Adolescent↗
PubMed1993

Percutaneous tracheostomy.

Percutaneous dilational tracheostomy (PDT) originated in the USA and now an increasing number of UK centres are adopting the technique. It compares favourably with traditional surgical tracheostomy; PDT can be performed more satisfactorily at the bedside, avoiding the transport of critically ill patients to the operating theatre. It is a more rapid and convenient technique and evidence increasingly suggests that it is associated with significantly fewer and less severe complications. If early reports are confirmed by larger, carefully controlled trials, it is likely that PDT will largely replace conventional surgical techniques for the provision of tracheostomy in the critically ill. An improved risk-benefit ratio of PDT may favour earlier conversion of translaryngeal intubation to tracheostomy.

Female↗