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Biomedical subjects

H Vaghadia

Publications and source records attributed to H Vaghadia.

16 recordsLinked to original sources
PubMed1992

Continuous lumbosacral block using a Tuohy needle and catheter technique.

Three cases are reported where continuous lumbosacral block was performed using a catheter through an epidural needle technique. Good unilateral lower limb surgical anaesthesia was achieved in all three cases with successful blockade of the lumbar and sacral plexuses. A 17-gauge Tuohy needle was positioned between the transverse processes of L4 and L5 and an epidural catheter inserted into the space between the quadratus lumborum and psoas muscles. Forty to seventy millilitres of local anaesthetic were injected and resulted in good surgical anaesthesia within 12-20 min. Radiographic studies in these patients confirmed placement of the catheter in close proximity to the lumbosacral plexus. Experience in a further 12 cases is also reported. There were no side-effects. The technique is successful and is recommended when unilateral lower limb anaesthetic is required and when spinal and epidural anaesthesia are contraindicated.

Aged↗
PubMed1989

Comparison of end-tidal carbon dioxide, oxygen saturation and clinical signs for the detection of oesophageal intubation.

The reliability of various methods for detecting oesophageal intubation was assessed by means of a single blind study in rats. Both oesophagus and trachea were simultaneously intubated. The presence or absence of various clinical signs was noted during tracheal or oesophageal ventilation and arterial blood gases and end-tidal CO2 were measured. Oesophageal ventilation for one minute was associated with significant decreases (P less than 0.001) in pH, PaO2 and SaO2 and a significant (P less than 0.001) increase in PaCO2. Although mean PaO2 decreased by 70 per cent and mean SaO2 decreased by 31 per cent, 43 percent of rats failed to demonstrate a decrease in SaO2 below 85 per cent. Oxygen saturation was the least reliable method for detecting oesophageal intubation (sensitivity = 0.5, specificity = 0.9, positive predictive value (PPV) = 0.8). Chest movement was the most reliable clinical sign for detecting oesophageal intubation (sensitivity = 0.9, specificity = 1.0, PPV = 1.0). Oesophageal rattle was the second most reliable clinical sign (PPV = 0.9). Moisture condensation in the tracheal tube (PPV = 1.0) and abdominal distension (PPV = 0.9) were judged to be the least reliable because each had a high false negative rate of 0.3. The most reliable method for the early detection of oesophageal intubation in rats was end-tidal, CO2 (sensitivity 1.0, specificity = 1.0, PPV = 1.0). In addition, end-tidal CO2 when used in conjunction with the four clinical signs improved the reliability of these signs.

Abdomen↗
PubMed1989

Method for noninvasive determination of arterial PCO2 in anesthetized rats.

A method for the noninvasive determination of arterial PCO2 in mechanically ventilated rats is presented. In normotensive, rats under steady state conditions where a depth of anesthesia adequate to abolish spontaneous ventilatory effort was used, end-tidal CO2 and arterial PCO2 were highly correlated (r = 0.96; p less than 0.001). The regression equation for this relationship was: PaCO2 (mmHg) = 6.757 +/- 8.984 ETCO2(%). This method obviates the need for arterial cannulation and may be useful in neuropharmacological research in rats when knowledge of arterial CO2 alone is required.

Anesthesia↗
PubMed1988

Anaesthetic implications of the trismus pseudocamptodactyly (Dutch-Kentucky or Hecht Beals) syndrome.

The trismus pseudocamptodactyly syndrome is a relatively rare, autosomal dominant condition first described in 1969. Affected patients classically present with two main features: limited excursion of the mandible and flexion deformity of the fingers that occurs with wrist extension (pseudocamptodactyly). Foot deformities and a shorter-than-normal stature may also be present. The underlying abnormality is short muscle tendon units, which prevent normal growth and development. We reviewed the anaesthetic experience in three paediatric patients with the trismus pseudocamptodactyly syndrome and the pertinent clinical findings in three other members of the same family, spanning three generations. Limited mandible excursion was present in all six cases, but was not obvious preoperatively in the patients because of its subtle presentation. All three cases were successfully managed using mask anaesthesia with spontaneous ventilation, avoiding muscle relaxants. Attempts to visualize the larynx under anaesthesia were unsuccessful in two cases. Blind nasotracheal intubation was successful in one patient. Postoperatively, there were no problems with the airway.

Adult↗
PubMed1988

Use of a Doppler ultrasound stethoscope for intercostal nerve block.

Two cases with rib injuries are reported where intercostal nerve block without rib palpation was safely and successfully performed on six separate occasions using a Doppler blood-flow detector ultrasound stethoscope. A third case studied by a radiologist using a pulsed Doppler flowmeter, determined the source of the Doppler signals as originating from the intercostal artery. The significance of these findings is discussed.

Adult↗
PubMed1988

Evaluation of a postocclusive reactive circulatory hyperaemia (PORCH) test for the assessment of ulnar collateral circulation.

This prospective double-blind study compared Doppler assessment of the ulnar collateral circulation with the Allen's test and a postocclusive reactive circulatory hyperaemia (PORCH) test in 144 patients (288 hands). The PORCH test involves inflation of a blood pressure cuff on the upper arm to a supra systolic (+50 mmHg) pressure for two minutes. Prior to cuff deflation, both radial and ulnar arteries are occluded at the wrist; the cuff is then deflated and a 15-second period allowed so as to restore blood flow down to the wrist. Ulnar artery compression is now released and the time to revascularization measured. Fifty-eight per cent of hands with an abnormal Allen's test had a normal ulnar collateral circulation. Results of Allen's test were not significantly affected by patients' sex or smoking status (p greater than 0.1) but there was a significant difference (p = 0.001) in the false positive rates between patients over 40 years of age (0.2) and those under 40 years of age (0.03). Results of the PORCH test were not significantly affected by patients' age, sex or smoking status (p greater than 0.1). With a revascularisation time of 19 sec as a "cut off" for ulnar abnormality the PORCH test, unlike the Allen's test, was perfectly predictive of an abnormal ulnar collateral circulation and had no false positives.

Aged↗
PubMed1987

Airway resuscitation packs for nurses: a recommendation for their withdrawal.

Approximately one third of our hospitals appear to issue airway resuscitation packs (ARPs) to nurses responsible for the care of postanaesthetic and comatose patients. These packs contain instruments intended for use in overcoming airway obstruction. One hundred and eight nurses replied to a questionnaire designed to identify their knowledge of the instruments. The results indicate that nurses entrusted with ARPs were almost totally unfamiliar with the instruments and their application. The authors recommend the universal withdrawal of ARPs and suggest that nurses and doctors are taught to recognise airway obstruction and to manage it with simple manoeuvres not involving instrumentation.

Airway Obstruction↗