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Biomedical subjects

C S Reilly

Publications and source records attributed to C S Reilly.

At least 37 records · Page 2Linked to original sources
PubMed1995

Postoperative analgesia with transdermal fentanyl following lower abdominal surgery.

In a randomised, placebo-controlled, double-blind study involving 81 patients undergoing total abdominal hysterectomy, the postoperative analgesia provided by transdermal fentanyl given at 25, 50, or 75 micrograms.h-1 for 72 h was compared with a placebo group. The efficacy of the Transdermal Therapeutic System was related to the rate of fentanyl delivery, higher rates being associated with significantly lower visual analogue pain scores (24, 20, 17 and 13, for placebo, 25, 50 and 75 micrograms.h-1 respectively) and reduced patient controlled analgesia morphine requirements (44, 38, 33 and 31 mg respectively). Patients' overall sedation scores were not increased by transdermal fentanyl, but respiratory rates decreased with higher transdermal fentanyl dosage.

Administration, Cutaneous↗
PubMed1995

Utilisation of the pre-operative ECG.

The utilisation of the pre-operative ECG in patients undergoing routine surgery was investigated in 354 adult patients over a 2-week period. Sixty-four percent of patients had an ECG pre-operatively. An ECG was not performed in 17% of patients who, current hospital policy suggests, should have had one. In contrast, an ECG was performed in 33% of patients who, hospital policy suggests, have no need of one (all of which were normal), which represented 18% of the total number of pre-operative ECGs performed. In 62% of patients with known cardiac disease, and 44% of patients with strong risk factors for ischaemic heart disease (in the absence of known disease) the ECG was abnormal. This compares with only 7% of patients aged over 50 with no risk factors in whom the ECG was abnormal. These findings suggest that there is room for improvement in the utilisation of the pre-operative ECG, which may have cost implications.

Adolescent↗
PubMed1994

Gastric emptying is delayed at 8-12 weeks' gestation.

Gastric emptying was studied indirectly by paracetamol absorption in 20 patients at 8-12 weeks' gestation and also in 20 non-pregnant controls. Subjects received paracetamol 1.5 g in a tablet with 50 ml of water and remained semi-recumbent for 2 h while venous blood samples were obtained at 15-min intervals. The maximum concentration of paracetamol was significantly lower and the time to maximum concentration significantly greater in pregnant patients. In addition, the areas under the time-concentration curves at 60 and 120 min were significantly smaller in the pregnant group. These changes are indicative of a delay in gastric emptying at 8-12 weeks' gestation.

Acetaminophen↗
PubMed1994

Myocardial ischaemia during tracheal intubation and extubation.

The incidence of myocardial ischaemia during tracheal intubation and extubation was compared using ambulatory ECG monitoring in 60 patients undergoing a variety of different surgical operations. Seven patients had myocardial ischaemia after tracheal intubation and seven patients during tracheal extubation. The patients who developed myocardial ischaemia during tracheal extubation had significantly greater rate-pressure products immediately before tracheal extubation (P < 0.05) and 1 min after tracheal extubation (P < 0.01) compared with those patients who did not develop myocardial ischaemia during extubation.

Adult↗
PubMed1994

Induction of anaesthesia with eltanolone at different rates of infusion in elderly patients.

We have determined the effective dose of eltanolone (pregnanolone) required to induce anaesthesia in 30 ASA I and II patients aged 60 yr and over. Eltanolone 4 mg ml-1 was administered at a rate of 300 ml h-1 (group 1), 600 ml h-1 (group 2) or 1200 ml h-1 (group 3) until loss of consciousness, as judged by loss of verbal contact with the patient. Anaesthesia was induced successfully in all patients. The slower rates of induction were associated with a significant increase in induction time (ANOVA, P < 0.01) and a decrease in the induction dose (P < 0.01). There was a significant reduction in systolic arterial pressure after induction of anaesthesia in groups 2 and 3 (MANOVA, P < 0.01). This study suggests that the induction dose of eltanolone in unpremedicated older patients should not exceed 0.6 mg kg-1.

Aged↗
PubMed1993

Comparison of infusion rates of three i.v. anaesthetic agents for induction in elderly patients.

We have compared the effect of different rates of injection of 2.5% thiopentone, 0.5% methohexitone and 0.2% etomidate for induction of anaesthesia in 90 premedicated, elderly patients. The agents were administered by infusion pump at rates of 1200 ml h-1, 600 ml h-1 and 300 ml h-1, respectively until anaesthesia was induced as judged by loss of verbal contact with the patient. The times for induction were significantly greater with the slower infusion rates (thiopentone 41 s, 57 s and 91 s (P < 0.001); methohexitone 44 s, 62 s and 84 s (P < 0.01); etomidate 48 s, 59 s and 87 s (P < 0.001)). The doses were significantly smaller (P < 0.001) with the slower infusion rates for all three agents (thiopentone 5.0, 3.7 and 2.8 mg kg-1; methohexitone 1.00, 0.75 and 0.56 mg kg-1; etomidate 0.26, 0.15 and 0.11 mg kg-1). For each drug there was no significant difference in induction characteristics, oxygen saturation, heart rate or mean arterial pressure, at the different infusion rates.

Aged↗
PubMed1993

Lignocaine spray applicators are a potential source of cross-infection in the anaesthetic room.

Ten percent lignocaine spray is in widespread clinical use as a means of suppressing responses to tracheal intubation. It is sprayed from a multidose container into the glottis and on to the vocal cords through an applicator nozzle, which may be used on successive patients. We have investigated the likelihood of the contamination of these nozzles, with patients' mouth flora. Spray applicators from four of the 20 cases investigated showed contamination with potential bacterial pathogens. We therefore recommend that lignocaine spray should not be applied to successive patients using the same applicator nozzle.

Adolescent↗
PubMed1993

Anaesthetists' attitudes to parental presence at induction of general anaesthesia in children.

Attitudes of anaesthetists of various grades working in different types of hospital in England and Wales, to parental presence in the anaesthetic room during induction of anaesthesia in children were assessed by means of a postal questionnaire. Of the 300 questionnaires sent out, 244 (82%) were completed. The majority of anaesthetists were in favour of parental presence in the anaesthetic room for induction of anaesthesia in children over the age of 1 year undergoing routine day case surgery. A small but significant number expressed reservations about some aspects of parental presence. The grade of anaesthetist and type of hospital did not appear to influence the response.

Ambulatory Surgical Procedures↗
PubMed1993

An evaluation of the effect of vasodilatation on oxygen saturations measured by pulse oximetry and venous blood gas analysis.

Measurements of arterial oxygen saturation were estimated using a pulse oximeter under conditions of reactive hyperaemia in the arms of 10 volunteers. Oxygen saturation measured by pulse oximetry was significantly lower, and venous oxygen saturation measured by co-oximetry was significantly higher, in the hyperaemic arm than in the other arm. Pulse oximeters analyse the pulsatile component of blood flow and exclude nonpulsatile causes of absorption in estimating arterial oxygen saturation. The pulsatile component is assumed to be purely of arterial origin. However, other vessels may pulsate when vasodilatation occurs and pulse oximeter saturation readings taken under these conditions may not give a true reflection of arterial saturation.

Arm↗
PubMed1993

A combined chest drain and intrapleural catheter for post-thoracotomy pain relief.

This study examined the effectiveness of a new type of chest drain, which incorporates an additional lumen within its wall to facilitate the administration of intrapleural bupivacaine. Nine patients who received a bolus dose of 1.5 mg.kg-1 bupivacaine with 1:200,000 adrenaline through this chest drain used less morphine, and had lower visual analogue pain scores in the first 6 h after thoracotomy than patients in whom a standard chest drain had been used. Bupivacaine levels were found to be within safe limits in all patients.

Bupivacaine↗
PubMed1993

Effects of sedation and supplemental oxygen during upper alimentary tract endoscopy.

The effects of supplemental oxygen therapy on arterial oxygen saturation (SaO2) in unsedated and sedated patients have been studied using pulse oximetry. Hypoxia (minimum SaO2 92% or less) occurred in 41% of unsedated patients breathing room air but in only 11% (p < 0.01) of those receiving supplemental oxygen (41/min) by nasal cannulae. Comparable effects were seen in sedated patients (60% versus 16%, respectively, p < 0.01). Hypoxia during upper alimentary tract endoscopy is common with or without sedation and can be reduced by supplemental oxygen.

Adolescent↗
PubMed1993

Anaesthesia and the obese patient.

The obese patient is likely to have pre-operative impairment of cardiovascular and respiratory function. These impairments will tend to increase in the per- and post-operative period and place the patient at risk of myocardial ischaemia and hypoxaemia. The physical effects of obesity mean that all patients require endotracheal intubation during anaesthesia and this may be difficult to achieve. The difficulties in moving and positioning the patient and difficulties in gaining access for monitoring and venous cannulation add to the problems. Anaesthesia and surgery may present a considerable risk for obese patients and should not be undertaken without full understanding of the potential problems.

Anesthesia↗
PubMed1992

Relationship between hypoxaemic and cardiac ischaemic events in the perioperative period.

We have used continuous and concurrent monitoring of arterial oxygen saturation (SpO2) and ECG to study the relationship between hypoxaemia and silent myocardial ischaemia in the perioperative period in 11 patients with cardiovascular disease. Ischaemic and hypoxaemic events occurred in all patients. Many events were shortlived and occurred independently of each other. However, our results suggest a close correlation between the duration of hypoxaemia and myocardial ischaemia. Ischaemia is more likely to occur if an episode of hypoxaemia is prolonged (beyond 5 min; P less than 0.01, chi square) and severe (SpO2 less than 85%; P less than 0.05, chi square).

Aged↗