Biomedical subjects
Publications and source records attributed to D A Jewkes.
Three adults are described who developed life-threatening hypotension following intravenous codeine phosphate. It is recommended that codeine phosphate should not be given intravenously to adults.
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A technique is described for the anaesthetic management of trigeminal nerve thermocoagulation by administration of repeated doses of midazolam and flumazenil. "Wake-up" times after administration of flumazenil in 20 patients were shorter than those reported during spontaneous recovery from methohexitone or propofol anaesthesia. The midazolam dose required for a second phase of sedation after antagonism of the first with flumazenil was significantly less than that for the first phase of sedation. There was no evidence of postoperative resedation. Reversal of sedation was associated with an increase in arterial pressure.
We report a case in which laminectomy was performed in a patient with symptoms attributed to lumbar canal stenosis. The patient developed paraplegia in the early postoperative period. Further investigation revealed a dural arterio-venous malformation. This was treated surgically, producing some neurological recovery. The possible mechanisms for the perioperative deterioration and their implications for anaesthesia are discussed.
A 38-yr-old woman who was 35 weeks pregnant presented with a subarachnoid haemorrhage, secondary to a ruptured anterior communicating artery aneurysm. Following initial recovery, she subsequently underwent simultaneous elective Caesarean section and clipping of the aneurysm. The anaesthetic management of the case is described and discussed.
In a double-blind, double-dummy study, the efficacy of topical 5% EMLA cream was compared with that of lignocaine infiltration in alleviating the pain of arterial cannulation. Forty unpremedicated adults were allocated randomly to four groups to receive EMLA cream alone, EMLA and 0.9% saline infiltration, EMLA and 1% lignocaine infiltration or placebo cream and 1% lignocaine infiltration. Following arterial cannulation, pain was assessed by the patient using a visual analogue score and by an independent observer using a four-category verbal rating score. Significantly lower pain scores were observed in all patients receiving EMLA compared with those receiving placebo cream and lignocaine infiltration by both patient (P less than 0.01) and observer (P less than 0.001) assessments. There were no significant differences between the three EMLA groups.
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Explore the source record for details and available documents.