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Biomedical subjects

D P Tomkins

Publications and source records attributed to D P Tomkins.

5 recordsLinked to original sources
PubMed1996

Needleless and sharp-free anaesthesia.

Accidental occupational infection of anaesthetists from patient body fluids is a very real and potentially fatal risk that will be significantly reduced with the routine use of universal precautions and the adoption of specific safe work practices. Employers are required by law to provide a safe working environment and safe systems for work which anaesthetists should implement according to recommendations in this paper. A protocol should be available to be acted upon in the event of occupational parenteral, mucous membrane and non-intact skin exposure to infected patient body fluids. Recommendations are made in six major areas of clinical practice which anaesthetists should adopt to minimize risks to themselves and other healthcare workers: loading syringes, cannulating blood vessels, administering intramuscular (IM) or local anaesthetic injections, administering intravenous (IV) drugs, use of sutures and surgical instruments by anaesthetists and the safe disposal of needles, glass ampoules and other sharp materials. Despite the known risks and the development of these safe practices there is poor compliance by anaesthetists with measures to safeguard themselves and others.

Accident Prevention↗
PubMed1989

Patient-controlled analgesia in children.

The use of patient-controlled analgesia is described for forty children who had undergone major orthopaedic or general surgery. Ages ranged from 6 to 18 years (mean 11.4 years) and PCA was used for an average of 46.2 hours postoperatively. Morphine requirements overall averaged 40.5 micrograms/kg/hr (SD 22.6). Requirements for the first six hours were not significantly different to a similar period 24 hours later. There was a large individual variation for patients undergoing similar procedures. Patients undergoing scoliosis surgery required significantly more morphine than any other group of patients. Problems with patient-controlled analgesia have been of a minor nature. We conclude that patient-controlled analgesia is a suitable and safe method of pain relief for paediatric patients and that the lower age limit is that at which a child can understand the concept after suitable explanation. In this study children as young as six years were able to successfully use the method.

Adolescent↗
PubMed1988

Hypoxia in children following general anaesthesia.

The oxygen saturations of 152 children were studied for the first 30 minutes following general anaesthesia with a pulse oximeter. Thirty-six patients (24%) recorded oxygen saturations of less than 90% while breathing room air and in all cases this occurred during the first ten minutes. Intubation (P less than 0.001), use of muscle relaxants (P less than 0.01), intravenous induction (P less than 0.01) and duration of anaesthesia of greater than one hour (P less than 0.02) were all associated with an increased incidence of hypoxaemia. There was no significant correlation with age, weight, procedure, time to wakening, or use of opiates. Clinical signs correlated poorly with hypoxaemia and it is recommended that all children should receive supplementary oxygen during transport to recovery wards and for at least the first ten minutes in recovery following general anaesthesia.

Adolescent↗
PubMed1987

Oral premedication in children.

Preoperative and postoperative sedation, postoperative analgesia and vomiting were assessed following four different oral premedications in 143 children aged 1-10 years, weighing 10-30 kg, and undergoing elective adenotonsillectomy or inguinal surgery. Diazepam, diazepam combined with droperidol, trimeprazine and trimeprazine combined with droperidol were compared in a double-blind trial in conjunction with a standardised inhalational anaesthetic technique employing an intraoperative narcotic. Trimeprazine produced significantly more preoperative sedation (P less than 0.001) and was associated with enhanced postoperative analgesia (P less than 0.01). The incidence of postoperative vomiting was significantly less in the group receiving trimeprazine (P less than 0.001). The addition of droperidol to diazepam and trimeprazine only marginally improved the performance of those drugs but significantly prolonged postoperative recovery times. This was more marked when droperidol was combined with trimeprazine.

Child↗