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Biomedical subjects

I D Hall

Publications and source records attributed to I D Hall.

7 recordsLinked to original sources
PubMed1986

Anaesthesia for the achondroplastic dwarf.

Over the past three years, 36 anaesthetics were administered to 27 patients with achondroplastic dwarfism. Twenty-four patients underwent craniectomy for foramen magnum stenosis. Sixteen of the operations were undertaken in the sitting position with nine incidents of venous air embolism (VAE), all of which occurred in patients under 12 years of age. Six major complications occurred: two C-1 level spinal cord infarctions, two brachial plexus palsies, one severe macroglossia, and one accidental extubation. Intravenous access in the small child with achondroplastic dwarfism is made difficult because of the excess, lax skin and subcutaneous tissue. Airway management and laryngoscopy were not difficult and we found that endotracheal tube size was best predicted by the patient's weight and not age. Blood loss was 38 +/- 9 mg X kg-1 in the prone position (n = 8) and 18 +/- 4 mg X kg-1 in the sitting position (n = 16), and was related to the surgical procedure rather than to dwarfism. Our data indicate that complications are more likely to occur in the sitting position, and that these complications are of a serious nature, and every precaution should be taken to avoid their occurrence.

Achondroplasia↗
PubMed1985

Expiratory valves and anaesthetic reservoir bags. The implications of scavenging.

The pressure-volume characteristics of 24 new and old '2-litre' anaesthetic reservoir bags of three different makes were measured. When inflated with gas to a pressure of 50 Pa all the new bags and six used ones contained 1.6 litres and when filled with 2 litres of gas, the pressure within them exceeded 700 Pa. The opening pressures and pressure drops to 30 litres/minute gas flow of scavenging adjustable pressure limiting valves were also investigated. Tests were carried out on 44 valves of four different types, all with their adjusting screws in the fully open position. All the valves had low opening pressures and pressure drops which were both further decreased when the orientation of the valves was changed to the inverted position. A substantial proportion of them remained permanently open. After one year's use both opening pressure and pressure drop tended to rise, the proportion of permanently open valves increased and the discs of some valves were damaged.

Anesthesia, Inhalation↗
PubMed1984

Intravenous regional analgesia. The danger of the congested arm and the value of occlusion pressure.

Two cases are described in which congestion of the arm occurred during intravenous regional analgesia. One case exhibited signs of serious local anaesthetic toxicity, while a significant plasma bupivacaine level was demonstrated in the other. In a study in a volunteer, leakage of contrast medium past the cuff was demonstrated radiologically only when congestion of the arm was produced. The Hoyle double cuff apparatus has narrow cuffs producing less tissue compression than a standard blood pressure cuff inflated to the same pressure. It may sometimes not occlude the brachial artery when inflated to a pressure based on the systolic arterial pressure measured with a standard cuff and congestion of the arm may then result. Increases in arterial blood pressure occurring during the procedure can also lead to congestion of the arm. Congestion may increase the risk of local anaesthetic agent leaking past the tourniquet into the systemic circulation. Recommendations are made about the choice of cuff gauge pressure and the prevention of arm congestion occurring during intravenous regional analgesia.

Adolescent↗