Biomedical subjects
Publications and source records attributed to E A Shipton.
Preventable mishaps resulting from human error contribute to anaesthetic risk, as demonstrated in the case report presented. The incidence of anaesthetic-associated deaths has fallen steadily since 1935, and general anaesthesia is now a very safe procedure, provided the anaesthetist takes the requisite precautions.
A 3-year-old White child was admitted to the critical care unit in a coma after a generalized convulsion. Codeine and salicylic acid were present in his plasma. The possible aetiology and management are discussed.
The effect of the premedicants atropine and glycopyrrolate on the cardiac dysrhythmic response to instrumentation and intubation was investigated. No significant increase in cardiac dysrhythmias such as bradycardia, atrial and ventricular extrasystoles was found (P greater than 0,01), but a significant increase in tachycardia occurred during induction (P less than 0,05) and intubation (P less than 0,01).
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The side-effect of pruritus was studied in 31 patients receiving epidural fentanyl 100 micrograms in 8 ml normal saline for postoperative analgesia. A control group of 30 patients received pethidine 1,5 mg/kg 4-6-hourly as required. Thirteen per cent of the patients who received epidural fentanyl experienced pruritus. However, this incidence was not considered unacceptable and the pruritus was mild and of short duration.
A 27-year-old White woman with syringomyelia underwent a caesarean section. The pre-operative preparation and anaesthetic management are presented, and the specific problems discussed.
A 71-year-old White man with a 7-year history of Parkinson's disease underwent prostatectomy. The pre-operative preparation and anaesthetic management of this patient are presented, and specific problems which may be encountered are discussed.
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An 8-year-old Black boy recently underwent surgery for the excision of a non-chromaffin laryngeal paraganglioma. The peri-operative management of this patient is presented. The specific problems involved and their importance to the anaesthesiologist and surgeon alike are discussed.
There is no longer any doubt that liver dysfunction following surgery and anaesthesia may sometimes be attributable to the inhalational anaesthetic agent halothane. Much controversy still surrounds the entity of halothane hepatitis, which continues to vex the practising anaesthesiologist. The incidence, causation, pathogenesis and diagnosis of halothane hepatitis are presented, and the safety and practicality of halothane administration in the presence of liver dysfunction are discussed.
A 61-year-old White man with variegate porphyria recently underwent coronary bypass surgery for ischaemic heart disease. His pre-operative preparation and anaesthetic management are presented. The specific problems involved and their importance to the anaesthesiologist are discussed.
Plasmapheresis has been used in the control of rhesus incompatibility in pregnancy, resulting in a marked reduction in serum cholinesterase activity. A number of these patients will subsequently require anaesthesia and hence be at risk from suxamethonium sensitivity. A caesarean section was performed on a 26-year-old patient with this condition. The pre-operative preparation and anaesthetic management are presented and the specific problems discussed.
Aspiration pneumonitis remains an important cause of morbidity and mortality in any anaesthetic practice. The pathophysiology, pre-operative prophylaxis and treatment of this syndrome are briefly discussed.
Renin and aldosterone values were measured in 20 patients undergoing coronary bypass surgery. Renin activity rose to a peak during bypass, falling a little after bypass and surgery. Aldosterone levels rose significantly during bypass, and continued to do so afterwards. This demonstrates a typical physiological stress response, evoking hormonal changes.
Hypercapnia developed during anaesthesia in 2 patients owing to a nitrous oxide cylinder being filled with carbon dioxide! The aetiology and effects of gross hypercapnia during anaesthesia are reviewed.
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A 12-year-old White girl underwent bilateral extracapsular lens extraction. She was known to be suffering from rheumatoid arthritis. The peri-operative handling and anaesthetic implications are discussed.