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Biomedical subjects

E W Cheam

Publications and source records attributed to E W Cheam.

11 recordsLinked to original sources
PubMed2001

Patient-controlled pethidine after major upper abdominal surgery: comparison of the epidural and intravenous routes.

We compared epidural (n = 17) and intravenous (n = 20) patient-controlled analgesia (PCA) using pethidine (bolus 10 mg, lockout interval 10 min, 4-h maximum dose 3 mg.kg(-1)) after total gastrectomy. We found that mean (SD) pethidine consumption in the first 24 h was 33% less in the epidural group [255 (85) mg] than in the intravenous group [379 (129) mg, p = 0.002], although most of this difference occurred in the first 8 h. Plasma concentrations of pethidine were lower at 8 h (p < 0.01) in the epidural group, but were similar at 24 h. Pain scores, side-effects, patient satisfaction and patient outcome were similar between groups. Epidural and intravenous pethidine PCA provided similar efficacy after major abdominal surgery, although the epidural route can reduce the amount of pethidine used initially.

Adolescent↗
PubMed2000

Randomised double-blind comparison of fentanyl, mivacurium or placebo to facilitate laryngeal mask airway insertion.

In a double-blind randomised study, we compared conditions during insertion of the laryngeal mask airway in 150 patients who received either fentanyl 1 microg.kg-1, mivacurium 0.04 mg.kg-1 or normal saline, before induction of anaesthesia with propofol 2 mg.kg-1. Insertion conditions, including mouth opening, swallowing, gagging or coughing, head or limb movement and ease of insertion, were each graded using a three-point scale. The median (interquartile range) summed insertion scores were more favourable with the use of fentanyl [8.0 (7.0-9.0)] and mivacurium [7.5 (6.8-8.3)] than with normal saline [9.0 (7.8-10.3); p < 0.01]. Fentanyl and mivacurium decreased swallowing and head or limb movement, and mivacurium improved mouth opening. Insertion conditions were similar between fentanyl and mivacurium, while both prolonged apnoea. Fentanyl and mivacurium are equally effective in facilitating insertion of the laryngeal mask airway following anaesthetic induction with propofol.

Adolescent↗
PubMed1999

Low dose mivacurium is less effective than succinylcholine in electroconvulsive therapy.

PURPOSE: To compare the efficacy of low dose (LD) mivacurium (0.08 mg.kg-1) with LD succinylcholine (0.5 mg.kg-1) in modifying seizure activity during electroconvulsive therapy (ECT). Partial muscle relaxation is used in ECT to prevent violent muscle contractions. Current practice is to use LD succinylcholine which has several undesirable side effects. METHOD: Sixteen depressed, but otherwise healthy, patients, aged 27-67 yr were studied. In a randomized, double-blind, cross-over study, either LD mivacurium or LD succinylcholine was given at consecutive ECTs 120 and 30 sec respectively before inducing ECT. Neuromuscular blockade following mivacurium was not reversed. Seizure modification was scored--0 = no seizure activity, 1 = over-modified, 2 = desired level, 3 = under-modified, 4 = unmodified. Duration of seizures, time to first breath and adequate ventilation, ability to protrude tongue and sustain hand grip for five seconds were recorded. Paired t-tests and Wilcoxon matched pairs test were used to compare data. P < 0.05 was considered significant. RESULTS: Seizure modification was better (mean (range)) after succinylcholine 2.06(1-3) than after mivacurium 2.56(2-4) (P < 0.05). Mivacurium was unsatisfactory in eight cases compared with two cases after succinylcholine. The study was terminated early because of unsatisfactory seizure control. Clinical assessments of recovery from both relaxants were similar. CONCLUSION: Low dose mivacurium is unsuitable for use in ECT.

Adult↗
PubMed1998

Anesthesia for a child with complex I respiratory chain enzyme deficiency.

The mitochondrial myopathies are a rare group of conditions affecting the respiratory chain and oxidative phosphorylation. The anesthetic management of a 6-year-old girl with complex I respiratory chain deficiency requiring surgery for a fractured hip is presented and discussed. Potential problems were masseter spasm, tendency to develop lactate acidosis, and malignant hyperthermia susceptibility. These problems were avoided by the use of a laryngeal mask airway, allowing the patient to spontaneously ventilate; caudal analgesia; and maintenance of anesthesia with a proprofol infusion.

Anesthesia↗
PubMed1998

The use of low-dose mivacurium to facilitate insertion of the laryngeal mask airway.

Ninety patients were assigned randomly in a double-blind manner to receive 0.9% sodium chloride, mivacurium 0.04 mg.kg-1 or mivacurium 0.08 mg.kg-1 intravenously, followed by propofol 2.5 mg.kg-1. A laryngeal mask airway (LMA) was inserted 90 s later. The LMA was positioned correctly during the first attempt in 87% of patients and this was not significantly altered by the use of mivacurium. However, mivacurium decreased the incidence of swallowing, coughing, movement and laryngospasm (p < 0.05). LMA insertion was graded as easy in 88% of patients who had mivacurium, compared with 50% in patients who had propofol alone (p < 0.05). The conditions during LMA insertion were similar after 0.04 or 0.08 mg.kg-1 of mivacurium. Patients were apnoeic for a mean (SD) time of 0.67 (0.72) min after propofol alone, compared with 1.72 (1.06) min and 3.05 (1.36) min in patients who also received mivacurium 0.04 and 0.08 mg.kg-1, respectively (p < 0.01). Patients who received mivacurium had a lower incidence of postoperative sore throat (24-30% vs. 53%) (p < 0.05). In conclusion, low-dose mivacurium facilitates LMA insertion and decreases the incidence of postoperative sore throat.

Adolescent↗
PubMed1995

The effect of nitrous oxide on the performance of psychomotor tests. A dose-response study.

The effect of different nitrous oxide concentrations on the performance of psychomotor tests (inspection time, tapping frequency, critical flicker fusion, picture memory and time sense) was investigated in seven healthy volunteers. The results show a dose-related impairment of memory, a reduction in tapping frequency and an increase in inspection time. A paradoxical increase in critical flicker-fusion threshold was observed. There was no effect on critical fusion-flicker threshold or time sense. Recovery was incomplete for memory tests performed 20 min after withdrawal of nitrous oxide. Subjective effects persisted for several hours.

Adult↗
PubMed1995

The use of a portable refractometer to measure desflurane.

The measurement of volatile anaesthetic agents by infrared absorption is liable to interference by other gases which absorb infrared light. In particular, nitrous oxide may, in principle, interfere with the measurement of desflurane. On the other hand, the refractometer should be immune to such effects. We demonstrated that interactions may occur between desflurane and nitrous oxide with some gas analysers and that the refractometer remains a useful instrument.

Anesthetics↗