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Biomedical subjects

B Kay

Publications and source records attributed to B Kay.

At least 37 records · Page 2Linked to original sources
PubMed1987

The effect of sufentanil on the cardiovascular responses to tracheal intubation.

The effects of sufentanil 0.5 or 1 microgram/kg, given intravenously after induction of anaesthesia, on the cardiovascular responses to tracheal intubation were examined in a controlled, randomised, double-blind investigation. The control group of patients exhibited significant rises in arterial blood pressure and heart rate for 4 minutes after tracheal intubation. Heart rate exceeded 100 beats/minute and systolic pressure increased by over 20% in every patient. All patients moved or breathed within 10 minutes of the administration of suxamethonium. Sufentanil 0.5 microgram/kg prevented increases in the mean values of heart rate and arterial blood pressure, although increases were observed in five patients. Significant falls in the mean values of heart rate and arterial pressure occurred from 4 minutes after intubation until observations ended 15 minutes after induction of anaesthesia. Two patients moved or breathed during this time, although movement in response to nerve stimulation occurred in all patients 10 minutes after administration of suxamethonium. Sufentanil 1 microgram/kg was effective in suppressing a rise in heart rate or arterial pressure in every patient. Significant falls in these variables occurred from 2 minutes after tracheal intubation onwards. No patient moved or breathed for 15 minutes after induction of anaesthesia, although neuromuscular transmission was present 10 minutes after giving suxamethonium in each case.

Adolescent↗
PubMed1986

Atracurium and vecuronium: effect of dose on the time of onset.

The time intervals measured from the administration of either atracurium or vecuronium to maximum or 95% neuromuscular blockade (Tmax) were compared in 70 patients using the evoked compound action potential of the adductor pollicis muscle. Equipotent doses, calculated from the relationship between dose and response for both drugs obtained in an earlier study, were compared. The doses of atracurium and vecuronium ranged from 0.135 to 0.5 mg kg-1 and from 0.02 to 0.1 mg kg-1, respectively. The dose range for both drugs included the ED50, ED95 and the dose required to produce 100% blockade (ED"100"). No significant changes in mean Tmax occurred for doses of atracurium in the range 0.135-0.2 mg kg-1 and in the range 0.24-0.5 mg kg-1. Similarly, no change in Tmax occurred at doses of vecuronium in the range 0.02-0.05 mg kg-1 and 0.06-0.1 mg kg-1. Tmax changed significantly in the dose ranges atracurium 0.2-0.24 mg kg-1 and vecuronium 0.05-0.06 mg kg-1. There was no significant difference in Tmax when equipotent doses of atracurium and vecuronium were compared.

Adolescent↗
PubMed1986

Propofol and alfentanil infusion. A comparison with methohexitone and alfentanil for major surgery.

In 42 patients undergoing major surgery, anaesthesia was induced by intravenous alfentanil 10 micrograms/kg together with methohexitone 1.5 mg/kg or propofol 2 mg/kg. An infusion of six times these doses per hour was then started; the rate was varied subsequently as indicated by the monitoring of arterial blood pressure, heart rate, EEG and frontalis electromyogram. The mean duration of infusion was 76.7 minutes for propofol and 74.5 minutes for methohexitone and the infusion was stopped about 10 minutes before the end of surgery in each group. The induction dose differed, but the total dose requirement for the two drugs was similar. In every case, anaesthesia was satisfactory. Methohexitone caused a significant rise in mean pulse rate throughout anaesthesia (p less than 0.05, paired t-test). There was no change in mean pulse rate during propofol infusion. The dose of alfentanil used provided excellent control of autonomic reflexes, with negligible respiratory depression. Naloxone was not required. Propofol provided better anaesthesia than methohexitone, with fewer side effects (p less than 0.05, Chi squared test), easier control of the level of narcosis and faster recovery (p less than 0.001, t-test after log transformation).

Adult↗
PubMed1986

Effect of disodium cromoglycate on activation of human eosinophils and neutrophils following reversed (anti-IgE) anaphylaxis.

Immunological release of histamine and lipid mediators is known to occur when basophils, contained in whole blood human leucocytes, are incubated with anti-IgE (reversed anaphylaxis). In the present study we show that IgE-dependent stimulation of basophils was associated with activation of bystander eosinophils and neutrophils, as assessed by enhanced complement (C3b) and IgG (Fc) rosettes, and increased cytotoxicity for complement-coated schistosomula of Schistosoma mansoni. These changes in eosinophil and neutrophil function were totally inhibited in a dose-dependent fashion by prior incubation with disodium cromoglycate (DSCG). In all in vitro systems examined, complete inhibition of enhancement was observed with concentrations as low as 10(-7) moles/l. In contrast, DSCG had no effect on histamine release, or the percentage of rosettes or cytotoxicity prior to anti-IgE stimulation. These results suggest that DSCG inhibits activation of inflammatory cells consequent to an IgE-dependent stimulus.

Anaphylaxis↗
PubMed1986

On-demand nalbuphine for post-operative pain relief.

Twenty-five patients with moderate to severe pain after major upper abdominal surgery chose to receive nalbuphine on demand from a Cardiff Palliator for pain relief. An initial i.v. injection of nalbuphine 20 mg was followed by 5 mg given over 90s in response to each successful demand. A maximum of 20 doses (100 mg) hr-1 of nalbuphine was available, plus additional bolus doses. Twelve patients obtained good pain relief and completed the 5 hour observation period. 13 patients withdrew from the study, 8 because of inadequate pain relief and 2 because of side-effects. At least half the patients who complained of inadequate pain relief at the time had no subsequent memory of the events. Despite high dosage in some cases (up to 200 mg in an hour) no clinically important cardiovascular or respiratory effects were observed.

Adult↗
PubMed1986

Intravenous anaesthesia for cystoscopy: a comparison of propofol or methohexitone with alfentanil.

Sixty out-patients undergoing cystoscopy were allocated randomly into two groups. No premedication was given. Induction of anaesthesia was preceded by intravenous alfentanil 7 micrograms kg-1 given over 20 s, followed by methohexitone 1.5-2 mg kg-1 or propofol 2 mg kg-1, given over 20 s. Anaesthesia was maintained by increments of alfentanil, methohexitone or propofol, given as required.

Adolescent↗
PubMed1986

[Reduction of circulatory reactions to intratracheal intubation--the effect of meptazinol].

A controlled, randomized, double blind assessment of the efficacy of meptazinol 3 mg kg-1 in reducing the circulatory responses to tracheal intubation was carried out in 20 ASA class I patients. After thiopentone 4 mg kg-1, meptazinol 3 mg kg-1 (ten patients) or saline (ten patients), and suxamethonium 1.5 mg kg-1 tracheal intubation was carried out, and the changes in pulse rate and arterial blood pressure compared between the groups and with control values. Significance was assessed at the 5% level (Student's t-test and paired t-test). Patients who received saline exhibited a rise in pulse rate, significant 1 and 2 min after intubation, and a significant rise in mean arterial pressure for 5 min after intubation. Patients who received meptazinol exhibited no significant rise in pulse rate, but a significant fall in pulse rate occurred from 5 min onwards. Mean arterial pressure rose significantly for 4 min after intubation but the rise was significantly less than that seen in the saline group. Suppression of spontaneous ventilation or movement in 50% of the group lasted for 7 min and 9 min after induction of anaesthesia in the control group and meptazinol treated group respectively. Meptazinol 3 mg kg-1 modifies the circulatory responses to tracheal intubation, preventing the tachycardia and reducing the hypertension, and causes a short delay in the onset of spontaneous respiration or movement.

Adult↗
PubMed1986

[A controlled double-blind trial of the possibilities of using nalbuphine in anesthesia in major surgical interventions on the upper abdomen].

A controlled, double-blind assessment of nalbuphine 0.3 mg kg-1 as an analgesic component of anaesthesia was made in 40 patients undergoing major upper abdominal surgery. The unpremedicated patients received thiopentone, alcuronium, nitrous oxide and oxygen, and either nalbuphine or saline. Enflurane was used to suppress autonomic nervous responses to surgery. Nalbuphine 0.3 mg kg-1 failed to influence the course of anaesthesia or the onset of post-operative pain, and produced no side-effects.

Anesthesia, Inhalation↗
PubMed1986

The extra work of breathing through adult endotracheal tubes.

A sinusoidal flow generator was connected to adult endotracheal tubes of sizes 5-10 and was used to simulate human ventilation. Measurement of the changes in pressure and flow allowed calculation of the work imposed on breathing by endotracheal tubes. The work of breathing increased with increasing ventilatory rate, tidal volume, and decreasing tube diameter. We discuss the suggestion that the work imposed on breathing by an endotracheal tube is a more appropriate unit for comparison than resistance to air flow.

Adult↗
PubMed1985

Blocking the circulatory responses to tracheal intubation. A comparison of fentanyl and nalbuphine.

The effects of three drug administration programmes on the haemodynamic responses to tracheal intubation have been compared. Thirty patients received thiopentone 4 mg/kg. Ninety seconds later, following the injection of either saline, nalbuphine 0.3 mg/kg or fentanyl 5 micrograms/kg, suxamethonium 1.5 mg/kg was given. The pressor response to tracheal intubation which occurred after saline was reduced after nalbuphine (p less than 0.05) but a tachycardia still occurred. In contrast, neither an increase in blood pressure nor heart rate occurred in those patients given fentanyl. It is concluded that nalbuphine 0.3 mg/kg is only partially effective in reducing the cardiovascular responses to laryngoscopy and tracheal intubation.

Fentanyl↗
PubMed1985

Controlled comparison of nalbuphine and morphine for post-tonsillectomy pain.

A controlled investigation was conducted to compare the effectiveness of morphine and nalbuphine in the prevention of pain and restlessness after tonsillectomy in children. Sixty children between 4 and 12 years old were randomly allocated to receive intramuscular morphine 0.2 mg/kg, nalbuphine 0.3 mg/kg or no medication approximately 5 minutes before the conclusion of surgery. Pain and restlessness were assessed 1 and 2 hours after injection, and side effects were recorded. The assessments were made double-blind. Both nalbuphine and morphine decreased restlessness and pain 1 hour (p less than 0.01) and 2 hours (p less than 0.05) after surgery. No significant differences were found between the two groups of patients who received opioids. Both nalbuphine and morphine caused more drowsiness than placebo 2 hours after surgery (p less than 0.001). Other side effects were uncommon. Nalbuphine may offer advantages compared with morphine in regard to safety and convenience of use for the treatment of post-tonsillectomy pain in children.

Child↗
PubMed1985

Meptazinol as an analgesic adjunct to total intravenous anaesthesia in cystoscopy patients.

Sixty-four unpremedicated patients undergoing cystoscopy received either intravenous meptazinol 2 mg/kg or saline in equivalent volume in a randomised, double-blind manner immediately before induction of anaesthesia with Althesin. Inclusion of meptazinol reduced the total dose of anaesthetic required, allowed a more rapid recovery and was associated with less movement in response to surgery. The patients in the control group tended to hyperventilate, and had lower end-tidal CO2 tension (p less than 0.001), and also higher pulse rates during surgery (p less than 0.01) than the meptazinol group. However, the patients who received meptazinol had a more frequent incidence of complications during induction and recovery (p less than 0.05).

Adjuvants, Anesthesia↗