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Biomedical subjects

B P Sweeney

Publications and source records attributed to B P Sweeney.

15 recordsLinked to original sources
PubMed2006

Liver enzyme induction and inhibition: implications for anaesthesia.

Recent breakthroughs in molecular biology have enabled a reclassification of drug metabolising enzymes based on their amino acid sequence. This has led to a better understanding of drug metabolism and drug interactions. The majority of these drug metabolising enzymes may be either induced or inhibited by drugs or by extraneous substances including foodstuffs, cigarette smoke and environmental pollutants. Virtually all drugs used in anaesthesia are metabolised by either hepatic phase 1 or phase II enzymes. This review considers the classification of drug metabolising enzymes, explains the mechanisms of enzyme induction and inhibition, and also considers how the action of drugs commonly used by anaesthetists, including opioids and neuromuscular blocking drugs, may be altered by this mechanism.

Analgesics, Opioid↗
PubMed2004

Watson and Crick 50 years on. From double helix to pharmacogenomics.

The second half of the 20th century has seen quantum leaps in our understanding of molecular biology. The technological advances, which facilitated the recent successful completion of the Human Genome Project, have provided the tools for deciphering the complexity of the human condition. At present, the function of only 50% of genes is known. However, as understanding of the human genome improves, a plethora of gene targets for treating disease will be uncovered - leading to therapies which will be considered revolutionary. Genome related science has begun to impact almost every facet of medicine including anaesthesia and intensive care. Better understanding of interindividual differences will enable better prediction of illness susceptibility as well as response to treatment. These insights will permit therapies to be tailored to individuals or racial groups. At present, there is only rudimentary knowledge of factors controlling gene regulation, but in the future, better understanding of gene-environment interactions and gene expression will enable pharmaceutical companies to develop new therapies and permit clinicians to optimise their effects, without recourse to current laborious testing regimens. As genomic science progresses, new ethical, legal, social and philosophical dilemmas will also continue to emerge.

DNA↗
PubMed2002

Sevoflurane vs. isoflurane: a clinical comparison in day surgery.

Discharge times after ambulatory surgery are determined by postoperative complications and in particular by the presence and severity of nausea and vomiting. Sevoflurane has become a popular agent for day-case surgery despite little evidence of clear advantages over current alternatives. We compared this agent with isoflurane in day-case patients undergoing knee arthroscopy in order to quantify the incidence of complications associated with each agent. One hundred and eighty patients received a standardised anaesthetic induction with propofol and fentanyl followed by maintenance with either isoflurane or sevoflurane. Standardised postoperative analgesic and anti-emetic drugs were prescribed. Any intra-operative cardiovascular or respiratory instability was recorded. After surgery, nausea, vomiting and pain were assessed. Almost all patients made an uneventful recovery and were discharged as scheduled. There was a significantly higher incidence of complications in the sevoflurane group. These included the presence of nausea and vomiting, and cardiovascular and respiratory complications. We found nothing to commend the routine use of sevoflurane rather than isoflurane in the context of day case anaesthesia.

Adolescent↗
PubMed2000

The effect of smoking on postoperative nausea and vomiting.

In an attempt to quantify the postoperative effects of smoking, 327 consecutive patients undergoing arthroscopic day case knee surgery were given a standard anaesthetic consisting of an intravenous induction with propofol and fentanyl followed by inhalational maintenance using isoflurane in an oxygen and nitrous oxide mixture. Pre-operatively, patients were asked inter alia to give details of social smoking habits. Postoperatively, patients were given standard analgesic and anti-emetic drugs. Prior to discharge patients were asked to give details of postoperative nausea and vomiting together with details of the severity of postoperative pain. There were 85 smokers and 242 nonsmokers. Of the 327 patients, a total of 42 (13%) complained of postoperative nausea and vomiting. Of the smokers, only 6% complained of postoperative nausea and vomiting in contrast to 15% of the nonsmokers (p < 0.05). It is postulated that enzyme induction is the most likely reason for this anti-emetic effect. Possible ways in which this clinically beneficial mechanism can be utilised to improve outcome after anaesthesia are discussed.

Adult↗
PubMed2000

Electronic data collection by trainee anaesthetists using palm top computers.

The Royal College of Anaesthetist requires that trainees wishing to specialise in Anaesthesia register with the College and keep a logbook documenting their experience and training in clinical anaesthesia. There are a number of advantages if such logbooks are kept in an electronic format. For the first time in the United Kingdom, we have evaluated the usefulness in a district general hospital of introducing a computerized system of record keeping based on a portable palm top computer. This has enabled the careful analysis of the individual work load of each trainee in the department by means of a specific program designed to generate a comprehensive report after the information from each individual has been downloaded on to a standard desk top computer. We have found a number of interesting and unexpected results and have highlighted ways in which the system may be improved.

Anesthesiology↗
PubMed1994

The incidence and severity of postoperative nausea and vomiting in patients exposed to positive intra-operative suggestions.

In a double-blind study, the effects of positive intra-operative suggestions on the incidence and severity of postoperative nausea and vomiting were studied in 60 patients randomly selected to undergo routine major gynaecological surgery. Patients who received positive suggestions suffered significantly less nausea and vomiting in the 24 h after surgery.

Anesthesia, General↗
PubMed1990

Acid aspiration prophylaxis in 288 obstetric anaesthetic departments in the United Kingdom.

The choice of drugs for acid aspiration prophylaxis in 288 obstetric anaesthetic departments in the United Kingdom was determined by questionnaire. The results are compared with a similar survey of anaesthetic departments 5 years ago. The prescription of sodium citrate and the H2 receptor antagonist ranitidine has superseded that of Mist. magnesium trisilicate.

Anesthesia, Obstetrical↗
PubMed1990

Intravenous cannulae colour coding. A perennial source of confusion.

There is no standard colour code for intravenous cannulae in the United Kingdom. A questionnaire was sent to the manufacturers to compile a table of available cannulae, and to assess their views and plans with regard to colour coding. Present moves to establish an international standard are outlined. A simple colour coding standard is proposed.

Catheterization, Peripheral↗
PubMed1987

The mechanisms of acupuncture analgesia.

Despite ever-increasing popularity as a quick, effective and safe means of pain control, acupuncture is still regarded with some suspicion in conventional medical circles. Nevertheless evidence is accumulating to support a firm physiological basis for its action, a fuller understanding of which will shed light on the essence of pain itself.

Acupuncture Therapy↗
PubMed1985

Anaesthesia in dysautonomia: further complications.

A case is described of a patient, known to be suffering from idiopathic autonomic neuropathy, who underwent general anaesthesia for repair of a fractured neck of femur. In addition to profound hypotension, unexpected respiratory depression occurred which has not previously been described in this condition. Other unusual features of this patient's condition are also discussed.

Anesthesia, General↗