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Biomedical subjects

I D Conacher

Publications and source records attributed to I D Conacher.

At least 19 recordsLinked to original sources
PubMed1992

Therapists and therapies for post-thoracotomy neuralgia.

An unknown number of patients who undergo thoracic surgery develop post-thoracotomy neuralgia (PTN). Many seek a cure. As with other chronic, benign pain conditions, a variety of treatment modalities may be offered by different specialists. Results of therapy in terms of patient satisfaction are not known. A record of 73 patients with PTN was made. It has been used to measure the incidence, the natural and therapeutic history and the success of the management of PTN. Over 70% of the cases received three or more of the treatment modalities and regimens that have been reputed to be of value. More than 50% were referred to three different types of specialist. No patient claimed to have become free of symptoms as a result of treatment and a significant proportion, not clearly defined, implied that therapy was either more disabling than PTN or made it worse. Side effects of drugs were blamed for the former, and invasive treatments, aimed at nociceptive pathways, were incriminated in the latter. It is reasoned that about 5% of patients undergoing thoracic surgery may require resources for the management of PTN. No patient studied thought that conventional treatments had brought about a cure. Some treatments, known to be deleterious, remain extant. This information reflects and corroborates that from other studies which suggests that multidisciplinary approaches are more appropriate for chronic benign pain conditions than management by isolated physicians using specific therapies.

Adult↗
PubMed1992

Anaphylactoid or carcinoid?

A patient with a carcinoid tumour and a history suggestive of carcinoid syndrome, but with no biochemical evidence in support, had a cardiovascular collapse during an anaesthetic with propofol and suxamethonium. Subsequent investigations suggested an anaphylactoid reaction to suxamethonium, but there were features in common with a carcinoid crisis. The necessity for a second anaesthetic soon afterwards posed a dilemma. In the event of a similar reaction during another anaesthetic, a management plan beforehand should include ready availability of appropriate drugs and the use of sympathomimetic drugs that are less likely to exacerbate the situation.

Acute Disease↗
PubMed1992

Instrumental bronchial tears.

Two case reports of bronchial tears following airway instrumentation are presented, one of which resulted in death. Both patients developed pneumothoraces and other complications after attempts had been made under general anaesthesia to insert bronchial stents. It appeared that bronchial tears were made during instrumentation with the stent introducer and these cases demonstrate that great care should be taken when rigid materials, such as plastic guides and bougies, are used blindly in the airway.

Adult↗
PubMed1991

Anaesthesia for patients with transplanted hearts and lungs undergoing non-cardiac surgery.

Heart and lung transplantation is now accepted as a means of treating some end-stage cardiopulmonary diseases. These patients may present with a wide variety of non-cardiopulmonary conditions requiring anaesthesia and surgery, possibly at a place distant from their original transplant centre. In general, for much elective, acute or even emergency surgery, if the allograft is functioning satisfactorily, these patients should present few problems during anaesthesia, provided the anaesthetist has some understanding of the pathophysiology of the transplanted organ and recognizes the differences (potential and specific to cardiopulmonary transplantation) between such patients and any other subject.

Adult↗
PubMed1991

A coaxial technique for facilitating one-lung ventilation.

A tube for bronchial intubation is described. A long (48 cm), small bore (5.0 mm internal diameter), cuffed, bronchial plastic tube is inserted coaxially within a large bore tracheal tube (10.0 mm) used for ventilation. The inner tube is designed primarily as a blocker to be inserted with a fibreoptic or optical bronchoscope, but can be effected blindly with a stylet. Several methods of inserting the inner tube and ensuring correct placement were used in 10 males undergoing thoracic surgery. If the bronchial cuff is inflated the tube can be used either as a blocker or as a conduit for suction and conventional and differential ventilatory techniques. Early clinical experience suggests that the technique is an alternative method of facilitating one-lung ventilation.

Adult↗
PubMed1990

Successful surgical management of bronchial dehiscence after single-lung transplantation.

A case of bronchial dehiscence despite bronchial omentopexy is described in a patient nine days after single-lung transplantation. Rethoracotomy was undertaken as soon as the diagnosis was established before superinfection occurred. Necrotic bronchus was excised, with the anastomosis sited distally on the donor bronchus. The omentum was necrotic, and the new anastomosis was wrapped with a vascularized pedicle of pericardium. Six months after this procedure, the patient remains well.

Anastomosis, Surgical↗
PubMed1990

Isolated lung transplantation for pulmonary fibrosis.

The peri-operative anaesthetic management of 11 patients with pulmonary fibrosis undergoing single-lung transplantation is presented. Intra-operative problems, the early postoperative phase of recovery and intensive care, and other incidents in which general anaesthesia was required for the management of complications, are featured. Results, both short- and long-term, are mentioned. Major intra-operative events that cause concern appear to be related to the severity of the presenting illness and the development of respiratory failure. Others have reported the development of intra-operative cardiac failure. All cases were successfully managed operatively using conventional one-lung anaesthesia, although resort to partial cardiopulmonary bypass may have been indicated in some. The indications and attitudes to utilising cardiopulmonary bypass in the evolution of techniques for facilitating single-lung transplantation are reviewed.

Adult↗
PubMed1989

Early results of single lung transplantation in patients with end-stage pulmonary fibrosis.

Three patients underwent single left lung transplantation for end-stage pulmonary fibrosis between June and November 1987. Preoperatively all were housebound, receiving continuous, supplemental oxygen, and their pulmonary function had deteriorated despite corticosteroid and cyclophosphamide therapy. Pulmonary preservation was by means of pulmonary arterial perfusion with modified Euro-Collins solution, 60 ml/kg, at 4 degrees C with adjunctive iloprost (synthetic prostacyclin) infusion. The heart from each donor was used successfully for transplantation. Good early graft function enabled extubation 11, 46, and 96 hours after transplantation. An omental wrap was used around the bronchial anastomosis, and bronchial healing was satisfactory in all. All patients had episodes of pulmonary rejection diagnosed by a combination of symptoms, chest x-ray infiltrates, the exclusion of pneumonitis by bronchoalveolar lavage, and prompt response to "pulse" steroid therapy. Two of the three patients had three episodes of opportunistic pulmonary infections: Herpes simplex pneumonitis, Pneumocystis carinii infection, and Aspergillus pneumonitis. The three patients were discharged from the hospital after 5, 6, and 7 1/2 weeks, respectively. The first and third patients remain alive and well, living essentially normal lives 24 and 19 months after transplantation with no evidence of arterial desaturation on exercise testing while breathing room air. The second patient had symptoms of deteriorating lung function with a progressive decline in forced expiratory volume in 1 second, vital capacity, and diffusion capacity despite repeated "pulse" therapy with combinations of methylprednisolone, antithymocyte globulin, and OKT3 (Ortho Diagnostic Systems Inc., Raritan, N.J.). An open lung biopsy specimen showed obliterative bronchiolitis, and this patient underwent orthotopic lung retransplantation, on the right side. Despite excellent early graft function and early extubation, he died of uncontrolled rejection and general debility after 3 weeks. This early experience in our center with two of three patients surviving 19 to 24 months, respectively, confirms the restoration of good pulmonary function and near normal life-style in patients with end-stage pulmonary fibrosis after single lung transplantation, as first reported by the Toronto Lung Transplant Group. We have used an alternative method of lung preservation (cold crystalloid pulmonary perfusion as opposed to topical cooling, used by the Toronto group), which provided excellent pulmonary preservation up to and beyond 4 hours' storage.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1988

Anaesthesia for isolated lung transplantation.

The anaesthetic management of a patient undergoing successful, left-sided orthotopic single lung transplantation is presented. Problems, specific to the operation, are featured and discussed.

Adult↗
PubMed1988

Isolated lung transplantation: a review of problems and guide to anaesthesia.

Some recipients of isolated, orthotopic lung transplants have now survived to leave hospital with greatly improved quality of life. Inevitably, the successful demonstration of the feasibility of these operations means that transplant centres throughout the world may wish to participate in a lung transplant programme. The indications and preparations for, and some of the implications of, these operations are discussed and some of the relevant literature, pertaining to perioperative anaesthetic management, reviewed. Successful transplantation has vindicated the policy that anaesthesia for these patients can be managed with methods conventional for pulmonary resection, and without resort to cardiopulmonary bypass. Key operative points highlighted, and management factors, based on practical experience, are suggested to provide guidelines for the benefit of those anaesthetists who may be involved in lung transplantation.

Adult↗
PubMed1988

Resin injection of thoracic paravertebral spaces.

Stained, quick setting resin was injected into the thoracic paravertebral spaces of six cadavers to assess the suitability of this material for delineating the spread of injected substances in an area of the human body which is being re-evaluated currently as a repository for analgesic drugs. The distribution and spread of the resin in relation to intercostal spaces, vertebral bodies and the spinal cord were noted, and compared with other studies.

Aged↗
PubMed1987

Postoperative paravertebral blocks for thoracic surgery. A radiological appraisal.

Five patients who underwent thoracic operations had an extradural catheter placed in the paravertebral space. X-ray contrast was injected through the catheters. In those who had detectable analgesia, contrast spread extensively, laterally, along one intercostal space, and up and down the paravertebral spaces. In one patient, contrast appears to have entered the extradural space and, in another who had no detectable analgesia, the contrast was probably dispersed intrapleurally. The significance of these findings is discussed.

Adult↗
PubMed1987

Carbon dioxide laser bronchoscopy. A review of problems and complications.

The records of 20 patients who underwent carbon dioxide laser bronchoscopy were analysed retrospectively. Many of the cases presented with evidence of severe obstruction of the trachea or major bronchi and were regarded as highly at risk from anaesthesia. The majority of problems in the 35 laser sessions related to the use of a rigid bronchoscope for delivering the laser and to the ventilatory difficulties associated with the airway pathology. Invasive arterial monitoring for blood gas analysis and blood pressure measurement proved essential to detect and correct changes of a potentially serious nature. This experience is compared and contrasted with that of others.

Adult↗