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D J Hatch

Publications and source records attributed to D J Hatch.

At least 37 records · Page 2Linked to original sources

Maturation of porcine tracheal cholinergic and inhibitory non-adrenergic, non-cholinergic innervation.

It is known that both excitatory cholinergic neural activity and nitric oxide (NO) release from inhibitory non-adrenergic, non-cholinergic (iNANC) nerves are important determinants of adult human airway smooth muscle tone. However, the level of cholinergic and iNANC activity in the newborn is unknown. Therefore, isolated trachealis muscle strips were obtained from neonatal, 10-day-old, and adult pigs. To quantify cholinergic nerve activity, isometric contractions were elicited by stimulating the nicotinic receptors of the cholinergic intramural ganglia with dimethyl-phenyl-piperazinium (DMPP). After ganglionic blockade with hexamethonium, the post-ganglionic cholinergic nerves were subjected to electrical field stimulation (EFS). To assess whether DMPP and EFS were also stimulating nitric oxide release from iNANC nerves, the stimulations were repeated after NO-synthase inhibition with 3 x 10(-5) M NG-monomethyl-L-arginine acetate (LNMMA). All responses were expressed as a percentage of maximal response to 10(-4) M acetylcholine. Although no significant age-related differences in the contractile responses to DMPP were demonstrated between the three age groups, the EFS responses were significantly different. At EFS frequencies of 1 and 2 Hz the responses of all three groups were different (P < 0.05, unpaired t-test). At frequencies of 0.125 and 0.5 Hz the contractile responses in the neonatal and 10-day-old groups were less than in the adult animal tissues (P < 0.05, unpaired t-test). At 4 Hz and above, the responses of the 10-day-old and adult groups became greater than the neonatal (P < 0.05, unpaired t-test). LNMMA did not significantly increase the contractile responses to DMPP at any age. Only in the neonatal rat and 10-day-old groups was a significant increase of the EFS frequency responses by LNMMA demonstrated (140.4 +/- 38.2% and 144.2 +/- 41.2%, respectively, at 0.5 Hz, ANOVA, P < 0.001). In conclusion, the DMPP responses suggest that the neonatal porcine cholinergic innervation is mature at birth. This contrasts with a frequency-dependent increase in EFS responses from birth. This may be due in part to a relative increase in iNANC modulation of post-ganglionic cholinergic activity at birth. This mechanism is not responsible for the increase in higher EFS frequency responses with post-natal maturation. Inhibitory iNANC activity may serve a protective role in the newborn, given the reported hyper-responsiveness of airway smooth muscle, small airway caliber, and high chest wall compliance at this age.

Adult↗

Rapid inhalation induction in children: 8% sevoflurane compared with 5% halothane.

Sevoflurane has a lower blood-gas solubility and a less pungent odour than halothane; this may allow more rapid induction of anaesthesia. In a randomized, blinded study, we compared the induction characteristics of maximum initial inspired concentration of 8% sevoflurane and 5% halothane using conventional vaporizers in children aged 3 months to 3 years. There was no statistically significant difference in induction times between the two groups: mean times to loss of consciousness were 1 min 12 s (SD 18 s, range 40 s-1 min 44 s) for sevoflurane and 1 min 16 s (SD 17 s, range 50 s-1 min 52 s) for halothane, although these times were shorter than in previous studies using a gradual increase in vapour concentration. A small number of complications were noted in both groups, although none interfered with induction of anaesthesia. Struggling scores were lower in the sevoflurane group than in the halothane group (chi-square for trends = 6.34, P < 0.02). A significant number (11 of 15) of parents of children in the sevoflurane group who had previous experience of halothane induction preferred sevoflurane (chi-square for trends = 4.03, P < 0.05). We conclude that with this technique, induction was rapid with both sevoflurane and halothane. Our assessment of patient struggling and parents' perceptions suggests that induction with sevoflurane was more pleasant than with halothane.

Anesthesia, Inhalation↗

A comparison of the induction characteristics of sevoflurane and halothane in children.

The induction characteristics of sevoflurane and halothane were compared in 81 children aged 6 months to 6 years. The mean time taken to achieve loss of eyelash reflex was significantly shorter with sevoflurane than with halothane (sevoflurane, mean time (SD) 1 min 41 s (35 s), halothane, mean time (SD) 2 min 17 s (43 s), t = 4.11, p = < 0.01). The mean time taken to complete induction (to achieve steady spontaneous ventilation and small pupils with central gaze) was also shorter in children induced with sevoflurane (sevoflurane, mean time (SD) 3 min 58 s (1 min 8 s), halothane, mean time (SD) 4 min 50 s, (1 min 27 s), t = 2.29, p = 0.027). Effects on heart rate, blood pressure and oxygen saturation during induction were similar for both agents. There were no major complications during induction with either halothane or sevoflurane.

Anesthesia, Inhalation↗

A comparison of the recovery characteristics of sevoflurane and halothane in children.

The recovery characteristics of sevoflurane and halothane anaesthesia were compared in 40 children aged 6 months to 6 years undergoing day case surgery. The mean time taken to open eyes after surgery had ended was appreciably and significantly shorter after sevoflurane than after halothane (sevoflurane, mean time (SD) 7 min 52 s (5 min 46 s), halothane, mean time (SD) 15 min 50 s (9 min 2 s), t = 3.32, p = 0.002). The time taken to be ready for discharge from the recovery unit to the ward was also significantly shorter after sevoflurane than after halothane (sevoflurane, mean time (SD) 12 min 46 s (4 min 11 s), halothane, mean time (SD) 19 min 13 s (9 min 48 s), t = 2.7, p < 0.01). However, more children were in pain and given analgesia after sevoflurane (p < 0.01) and the mean time to reach the criteria for discharge home was similar in both groups (sevoflurane, mean time (SD) 2 h 9 min (17 min), halothane, mean time (SD) 2 h 4 min (8 min)). There were no major complications in either group.

Ambulatory Surgical Procedures↗

A new critical incident monitor for use with the paediatric T-piece. In vitro evaluation and clinical experience with the Magtrak Infanta Electronic Respirometer.

In vitro studies and clinical evaluation suggest that the Magtrak Infanta Electronic respirometer provides a useful additional critical incident monitor for use with the paediatric T-piece. During ventilation with the Nuffield 200 ventilator and Newton valve it provides early warning of leaks or disconnections in the breathing system, airway obstruction and reduction in fresh gas flow. Some of these events may not be detected by conventional monitors.

Airway Obstruction↗

A comparison of sevoflurance to halothane in paediatric surgical patients: results of a multicentre international study.

Induction, emergence and recovery characteristics were compared during sevoflurane or halothane anaesthetic in a large (428) multicentre, international study of children undergoing elective inpatient surgical procedures. Two hundred and fourteen children in each group underwent inhalation induction with nitrous oxide/oxygen and sevoflurane or halothane. Incremental doses of either study drug were added until loss of eyelash reflex was achieved. Steady state concentrations of anaesthesia were maintained until the end of surgery when anaesthetic agents were terminated simultaneously. Time variables were recorded for induction, emergence and the first need for analgesia in the recovery room. In addition, in 86 of the children in both groups, venous blood samples were drawn for plasma fluoride levels during and after surgery. There was a trend toward smoother induction (induction of anaesthesia without coughing, breath holding, excitement laryngospasm, bronchospasm, increased secretion, and vomiting) in the sevoflurane group with faster induction (2.1 min vs 2.9 min, P = 0.037) and rapid emergence times (10.3 min vs 13.9 min, P = 0.003). Among the children given sevoflurane, 2% developed bradycardia compared with 11% in the halothane group. Postoperatively, 46% of the children in the halothane group developed nausea and or vomiting versus 31% in the sevoflurane group (P = 0.002). Two children in the halothane group developed cardiac dysrhythmia and were dropped from the study. In addition, a child in the halothane group developed malignant hyperthermia, received dantrolene, and had an uneventful recovery. Mean maximum inorganic fluoride concentration was 18.3 microM.l-1. The fluoride concentrations peaked within one h of termination of sevoflurane anaesthetic and returned rapidly to baseline within 48 h. This study suggests that sevoflurane may be the drug of choice for the anaesthetic management of children.

Adolescent↗

Comparison of the pharmacodynamics of ketamine in the isolated neonatal and adult porcine airway.

Ketamine inhibits contractions of adult airway smooth muscle by actions both within the smooth muscle cell and the vagal intramural ganglia. Its effects in the neonate are unknown, as physiological changes occur after birth in both of these structures. Isolated trachealis muscle strips from neonatal and adult pigs were contracted selectively by stimulation of the vagal intramural ganglia using dimethyl-phenyl-piperazinium (DMPP), the post-ganglionic vagus nerve using electrical field stimulation (EFS) and the smooth muscle cell itself using acetylcholine (ACh) in the presence of tetrodotoxin. The inhibitory effects of clinical concentrations of ketamine at each site were compared both within and between age groups. At both ages, ketamine 10(-4) mol litre-1 abolished (P < or = 0.001) and ketamine 10(-5) mol litre-1 attenuated (P < or = 0.001) the contractile responses to DMPP at the intramural ganglia. The inhibitory effect of ketamine 10(-4) mol litre-1 on ACh responses at the smooth muscle cell was greater in neonatal preparations (P = 0.025). Furthermore, only neonatal EFS and ACh responses were attenuated by ketamine 10(-5) mol litre-1 (P = 0.04 and P = 0.03). Ketamine 10(-4) mol litre-1 attenuated EFS responses in both age groups (P < or = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylcholine↗

Preoperative fasting for paediatric anaesthesia.

Preoperative fasting was introduced to reduce the risk and severity of aspiration pneumonitis. Adequate time (6h) must still be allowed before operation for solid foods to be emptied from the stomach. However, the overwhelming weight of evidence supports the practice of reducing the duration of the preoperative fluid fast for elective paediatric surgical patients [3, 15]. In children allowed free, clear fluids until 2 h before the scheduled time of anaesthesia, gastric contents and thus the risk of aspiration pneumonitis appears to be similar to those children who have endured a longer fast. Potential benefits of reduced thirst, better perioperative experience, improved compliance and reduced hypoglycaemia may be seen. Patients at risk of GOR and aspiration pneumonitis, including those presenting for emergency surgery, must receive special consideration. As aspiration pneumonitis is so rare, careful reporting of complications potentially related to a reduced fasting period is necessary.

Adolescent↗

Postal survey of paediatric practice and training among consultant anaesthetists in the UK.

A postal survey of previous paediatric anaesthetic training, current paediatric experience and management of an infant pyloromyotomy was undertaken among consultant anaesthetists in the UK. A total of 851 questionnaires were returned, giving a response rate of 31%; 352 (41%) consultants had at least one paediatric list each week, 180 (21%) anaesthetized more than one infant less than 6 months old each month and 373 (44%) had obtained more than 6 months' specialist training. Consultants trained most recently had received significantly longer (P < 0.001) specialist training than their senior colleagues: 558 (66%) consultants dealt with infants requiring a pyloromyotomy, 348 with one or two cases annually. Two-thirds preferred to use an i.v. induction technique and less than half used cricoid pressure. Choice of technique was related to the duration of specialist paediatric training and when it was received, but not to current paediatric anaesthetic experience. The results are discussed in relation to recently published recommendations on paediatric anaesthetic services.

Anesthesia↗

Specialist anaesthetic training and certification process in England.

Specialist accreditation in anaesthesia in the United Kingdom currently requires a minimum of six years recognised training after full medical registration. In future, the training programme will become more structured, with more emphasis on regular in-training assessment, and attempts are being made to reduce the overall training period. The Royal College of Anaesthetists has published a proposed plan for structured training and is evaluating the reliability and validity of traditional and newer methods of examination. It is one of the first postgraduate bodies to introduce the Objective Structured Clinical Examination (OSCE) into its examination structure. A more formal programme of Continuing Medical Education is also being considered.

Accreditation↗

Mechanisms of the relaxant action of ketamine on isolated porcine trachealis muscle.

Ketamine is a potent bronchodilator, but its mode of action is unclear. We have studied the effect of ketamine on the peripheral vagus nerve motor pathway of isolated porcine trachealis muscle. Postsynaptic nicotinic cholinergic receptors of the intramural ganglia were stimulated selectively with 1,1-dimethyl-4-phenyl-piperazinium iodide, post-ganglionic nerve fibres with electrical field stimulation (in the presence of hexamethonium) and muscarinic cholinergic receptors with acetylcholine (in the presence of tetrodotoxin). Ketamine 10(-4) mol litre-1 significantly shifted the concentration-response curves of acetylcholine (P < 0.02) and electrical field stimulation (P < 0.001) to the right and abolished the response to 1,1-dimethyl-4-phenyl-piperazinium iodide (P < 0.02). Ketamine also caused a concentration-dependent relaxation of muscle strips precontracted with acetylcholine. This was unaffected by propranolol. Ketamine relaxed muscle strips precontracted with potassium chloride, in the absence and presence of atropine. We conclude that ketamine interacts with the peripheral vagus nerve by decreasing the excitability of the postsynaptic nicotinic receptors of the intramural ganglia, and by affecting the muscarinic receptor, smooth muscle, or both. Beta-2 adrenoceptors are not involved in the mechanism of relaxation.

Acetylcholine↗