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Biomedical subjects

B Kay

Publications and source records attributed to B Kay.

At least 73 records · Page 4Linked to original sources
PubMed1977

Total intravenous anesthesia with etomidate. III. Some observations in adults.

An investigation was undertaken to determine the dosage of etomidate required to maintain sleep in adults undergoing surgery under regional local anesthesia. Premedication of diazepam 10 mg and atropine 0.5 mg was given, and sleep was induced and maintained by intermittent intravenous injections of etomidate 0.1/mg/kg, given whenever the patient would open his eyes on request. A mean overall dose of etomidate 17.4 microgram/kg/min. was required to maintain sleep, but great individual variation occurred, with older patients requiring less drug. The investigation was discontinued after 18 patients because of the frequency and intensity of side-effects, particularly pain and myoclonia, which caused the technique to be abandoned in two cases. It is considered unlikely that etomidate will prove to be the hypnotic of choice for a totally intravenous anesthetic technique in adults because of the high incidence of myoclonia after prolonged administration. In several patients uncontrollable muscle movements persisted for many minutes after complete recovery of consciousness.

Adolescent↗
PubMed1977

Total intravenous anesthesia with etomidate. I. A trial in children.

Eighty children, aged from 2 weeks to 14 years, were anesthetized using intravenous agents only. Anesthesia was induced by etomidate 0.3 mg/kg together with atropine and fentanyl 2 to 5 microgram/kg. Muscle relaxation was provided by suxamethonium, alcuronium or pancuronium. Unconsciousness was maintained using a continuous infusion of etomidate, initially 0.04-0.05 mg/kg/minute, but adjusted to the apparent requirements of the child. Oxygen, or oxygen/air mixtures were inhaled, or used for ventilation. Maintenance of anesthesia was assessed as good in only 85% of patients, with movement in response to surgery being seen in the remaining 15%. Unsatisfactory anesthesia was particularly associated with lack of experience in the technique, and unparalysed patients. Recovery was generally good, and rapid, with a mean waking time of 4.8 minutes. It is unlikely that this technique will find widespread use. It demands constant observation of the patient, looking for signs of consciousness; and trying to avoid having an awake, paralysed patient, or giving an overdose of etomidate.

Adolescent↗
PubMed1977

Total intravenous anesthesia with etomidate. II. Evaluation of a practical technique for children.

A practical technique for the administration of anesthesia to children is described, using only intravenous agents. Anesthesia was induced using etomidate 0.3 mg/kg, analgesia being provided by fentanyl or pentazocine, and muscle relaxation by suxamethonium or pancuronium. Unconsciousness was maintained by infusion of a 1% solution of etomidate given at a pre-determined rate of 30 microgram/kg/min. Paralysis was maintained throughout the period of surgical stimulation, in the majority of patients by continuous infusion of suxamethonium 0.1 mg/kg/min. The chosen rate of infusion of etomidate appears to be adequate to reliably maintain sleep in children, yet allow rapid recovery of consciousness when the infusion is stopped, thereby relieving the anesthetist of concern about these points. The maintenance of complete paralysis throughout operation removes the possibility of movement, the major cause of unsatisfactory anesthesia using only intravenous agents.

Adolescent↗
PubMed1976

A clinical assessment of the use of etomidate in children.

Etomidate 0.2 mg/kg i.v. was used to induce sleep in 198 children. It produced sleep rapidly and safely, with negligible effect on the cardiovascular system and little respiratory depression. Clinical acceptability was reduced by a 27% incidence of pain after injection, a 10% incidence of myoclonia and inadequate dosage in 19%. Etomidate has little analgesic activity and these problems can be reduced by the use of an analgesic as premedication or with induction of anaesthesia, by increasing the induction dose of etomidate to 0.3-0.4 mg/kg, or by changing the formulation of the solution.

Adolescent↗
PubMed1976

A dose-response relationship for etomidate, with some observations on cumulation.

In a within-patient comparison in 30 subjects, sleep was induced before e.c.t. by different doses of etomidate or methohexitone: etomidate 0.1 mg/kg, 0.2 mg/kg, 0.4 mg/kg or methohexitone 1.5 mg/kg. The duration of hypnotic effect was assessed by recording the time of spontaneous waking and later, of recovery of normal ocular muscle tone. Doubling the dose of etomidate produced a significant increase in both sleeping time and late recovery. Compared with methohexitone 1.5 mg/kg, etomidate 0.2 mg/kg provides an equal duration of sleep, but allows faster late recovery. In eight patients in whome sleep was maintained by repeated injections of etomidate 0.1 mg/kg as required, little evidence of cumulation was seen up to 27.5 min duration of sleep.

Adult↗
PubMed1976

Ketamine anaesthesia for medical procedures in children.

Ketamine hydrochloride 2 mg/kg, together with atropine 0.2 mg, has been given intravenously on 100 occasions on a general paediatric ward. No serious side effects occurred. Dreams followed in 4 children but did not reduce acceptability of the drug. In our hands it has greatly reduced the pain and distress of children undergoing many routine medical procedures, particularly the dread which builds up when these have to be repeated in the same child. It has also produced close to ideal conditions for the operator, and probably increased his efficiency by reducing the emotional strain which occurs when doing painful things to a frightened patient.

Adolescent↗
PubMed1976

Some experience of the use of etomidate in children.

Etomidate 0.2 mg/kg was used as an intravenous hypnotic to induce anesthesia in 198 children. If proved to be a safe and effective agent, with no appreciable side-effects on the cardiovascular or respiratory systems. The main problems in use were a high incidence (27%) of pain after injection, and a 10% incidence of significant myoclonia. In addition, 0.2 mg/kg was assessed as an inadequate induction dose of etomidate in unpremedicated children.

Adolescent↗
PubMedDate not supplied

Efficacy of bone marrow, blood, stool and duodenal contents cultures for bacteriologic confirmation of typhoid fever in children.

The relative efficacy of cultures made from duodenal contents (obtained by string capsules), bone marrow, blood and rectal swab was compared in 118 pediatric patients, 2 to 13 years old with suspected typhoid fever. Only 47% of children 2 to 6 years old tolerated the string device, as compared with 89% in children 7 to 13 years old (P less than 0.05). The four culture techniques were performed and at least one was positive for Salmonella typhi in 43 patients. Bone marrow cultures were positive in 84% of the confirmed cases, a sensitivity significantly greater than for duodenal contents (42%), blood (44%) and stool (65%) cultures. Higher recovery rates for blood cultures were found during the first week of illness than later (70 vs. 22%). Bone marrow cultures remain the most effective method for the recovery of S. typhi. Stool cultures appear to be more effective in children than in adults. Duodenal contents cultures offer little advantage in young (2 to 6 years old) children.

Adolescent↗