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Biomedical subjects

I G Kestin

Publications and source records attributed to I G Kestin.

At least 19 recordsLinked to original sources
PubMed1998

A comparison of intramuscular tenoxicam with intramuscular morphine for pain relief following tonsillectomy in children.

A double blind trial was conducted to evaluate the analgesic efficacy of intramuscular tenoxicam for pain relief following tonsillectomy in children. Fifty children, aged 3-10 years, were randomly allocated to receive intramuscular tenoxicam 0.75 mg.kg-1 or intramuscular morphine sulphate 0.2 mg.kg-1 after induction of anaesthesia. Although the tenoxicam group required significantly more postoperative morphine.(mean 57.8 micrograms.kg-1 compared with 26.9 micrograms.kg-1, P = 0.025), the total morphine dose was significantly reduced after tenoxicam (57.8 micrograms.kg-1 compared with 226.9 micrograms.kg-1, P < 0.0001). There was no difference between the quality of analgesia after discharge from recovery. The incidence of postoperative vomiting was significantly reduced after tenoxicam (20%) compared with morphine (71%).

Analgesics, Opioid↗
PubMed1998

Combining propofol with morphine in patient-controlled analgesia to prevent postoperative nausea and vomiting.

We have studied the antiemetic effects of propofol when mixed with morphine in a patient-controlled analgesia (PCA) pump after major gynaecological surgery. In a double-blind, randomized, controlled study, 50 women, ASA I or II, received a standardized anaesthetic comprising thiopental, morphine, atracurium, nitrous oxide and oxygen with enflurane, and received postoperative PCA with morphine mixed with either 1% propofol or lvelip. The PCA bolus was morphine 1 mg with propofol 5 mg or lvelip 0.5 ml, with a lockout time of 5 min. Postoperative nausea and vomiting (PONV) were assessed by the nursing staff using a four-point ordinal scale and by the patient using a visual analogue scale for 48 h after surgery. The two groups were similar in the potential factors influencing the incidence of PONV. There were no significant differences between the two groups in any of the study measurements of PONV. There were, no side effects after propofol. Propofol, when mixed with morphine in this dose combination for PCA, did not decrease the incidence of nausea and vomiting in women undergoing major gynaecological surgery.

Adult↗
PubMed1996

Morphine consumption in patients receiving rectal paracetamol and diclofenac alone and in combination.

Paracetamol and diclofenac have different mechanisms of action, and the combination may be more effective than each drug used alone in treating postoperative pain. In a double-blind, controlled design, we studied 60 patients undergoing elective abdominal gynaecological surgery, who received suppositories of paracetamol 1.5 g, diclofenac 100 mg or a combination of the two before the start of surgery. Patients received morphine in the intraoperative period, and cumulative morphine use from a patient-controlled analgesia system was recorded to measure the analgesic effect of the suppositories. Morphine consumption was greatest in the group that received paracetamol alone and lowest in the group given the combination (P < 0.01). There was no difference in the incidence of morphine-related side effects between the groups. We conclude that a diclofenac-paracetamol combination reduced the amount of morphine used compared with paracetamol alone.

Acetaminophen↗
PubMed1996

Infusions of subhypnotic doses of propofol for the prevention of postoperative nausea and vomiting.

We studied the antiemetic effects of a low dose infusion of propofol for 24 h after major gynaecological surgery in a double-blind, randomised, controlled trial. Fifty women of ASA physical status 1 or 2 undergoing major gynaecological surgery received an infusion of 1% propofol or intralipid at 0.1 ml.kg-1.h-1 for 24 h after surgery. Pain was managed using morphine delivered by a patient-controlled analgesia pump. The degree of postoperative nausea and vomiting was assessed by the nurses using a four-point ordinal scale, by the patients using a visual analogue scale and by the amount of rescue antiemetic given by the nurses. There were no differences between the two groups in any of the measures of postoperative nausea and vomiting during the first 48 h after surgery. Postoperative nausea and vomiting in the control group was less on the second day compared with the first postoperative day, but not in the propofol group. There were no side effects from the propofol infusion.

Adult↗
PubMed1995

A statistical approach to measuring the competence of anaesthetic trainees at practical procedures.

Cusum analysis is a statistical technique to distinguish deviations from an acceptable failure rate. The progress of anaesthetic trainees learning four practical procedures (obstetric extradural anaesthesia, spinal anaesthesia, central venous cannulation and arterial cannulation) was monitored from their first attempt using cusum analysis. Suitable acceptable and unacceptable failure rates for each procedure were chosen by consultant anaesthetists. For obstetric extradural anaesthesia, four trainees eventually achieved acceptable failure rates (5%) and the number of attempts required to demonstrate this statistically ranged from 29 to 185; three trainees had an unacceptable failure rate (10%) and five trainees had inconclusive records. For spinal anaesthesia, two trainees achieved an acceptable failure rate (10%) and the number of attempts required to demonstrate this statistically ranged from 39 to 67; two trainees had an unacceptable failure rate (20%) and four trainees had inconclusive records. One trainee demonstrated statistically an acceptable failure rate in arterial cannulation (20%) after 14 attempts and four trainees had inconclusive records. Two records of central venous cannulation were inconclusive. Some records showed variable failure rates which were sometimes associated with lack of practice or a change in technique. Cusum analysis can be used to monitor training in practical procedures and as a continuous audit of quality of clinical practice.

Anesthesia↗
PubMed1995

Haemodynamic effects of tracheally administered adrenaline in anaesthetised patients.

Ten patients undergoing arterial surgery in the leg received a combined general anaesthetic, which included muscle relaxation and intubation of the trachea, and a regional anaesthetic using a lumbar extradural catheter. The radial arterial pressure was measured. Adrenaline 0.1 micrograms.kg-1 was administered intravenously and the heart rate, arterial pressure and oxygen saturation were recorded every 15 s for 10 min. Adrenaline in 5 ml of saline was given into the trachea at 10 min intervals. The first was saline only, and successive injections contained 0.5 micrograms.kg-1, 1 microgram.kg-1, 2 micrograms.kg-1, and 3 micrograms.kg-1 of adrenaline. The mean maximum rise in systolic arterial pressure after adrenaline given intravenously was 30 (SD 11) mmHg, and 15 (SD 16) mmHg after the maximum dose of adrenaline given into the trachea (p < 0.05). The mean systolic arterial pressure was significantly increased between 45 s and 4.5 min after the adrenaline given intravenously, and 2 min after adrenaline given into the trachea. Of seven patients who received adrenaline 3 micrograms.kg-1 into the trachea, six had no noticeable effect and in the other patient, the increase in arterial pressure was less than 90% of the maximum rise after the adrenaline. We conclude that adrenaline given into the trachea is unreliable in humans with very large doses necessary in some patients to produce a clinically useful haemodynamic effect.

Aged↗
PubMed1995

Movement of oral and nasal tracheal tubes as a result of changes in head and neck position.

The tracheas of 20 ASA grade 1 and 2 patients were each consecutively intubated with an oral and nasal cuffed tracheal tube. Measurements of tube movement, as the position of the head and neck altered, were made with a fibreoptic bronchoscope. Both oral and nasal tubes moved an average distance of 15 mm towards the carina with head and neck flexion and 8.5 mm away with head and neck extension. Movement in both directions occurred with lateral rotation of the head. Optimal placement of tracheal tubes can be aided with a single guide mark placed 3 cm proximal to the cuff and 8 cm proximal to the distal end, which may reduce complications arising from this movement. This is a better method in women than inserting a pre-determined length of tracheal tube measured from the lips or nares. However, current guide marks vary in their position relative to the cuff and tip of the tube.

Adolescent↗
PubMed1992

Sighs and their effect on the breathing of patients anaesthetized with infusions of propofol.

Twenty-one spontaneous sighs were analysed from records of the breathing of 10 patients anaesthetized for 22-42 (mean 28.7) min with propofol infusions. Sighs occurred in eight patients, the rate varying between once in 29 min and four times in 26 min. There was no pattern in breaths preceding sighs, but the succeeding breaths were altered. On the first succeeding breath, tidal volume was reduced by a mean of 32% (95% confidence limits 19-44%; P less than 0.01) and inspiratory time by a mean of 15% (95% confidence limits 8-22%; P less than 0.01) of the means of the preceding breaths. These effects lasted on average at least 10 breaths. Expiratory time was usually slightly prolonged after a sigh, but this effect was less clear, less consistent and less prolonged. Sighs in patients anaesthetized with propofol reduce the ventilatory drive (in terms of mean inspiratory flow), and alter the timing, of succeeding breaths.

Adult↗
PubMed1992

Analgesia for labour and delivery using incremental diamorphine and bupivacaine via a 32-gauge intrathecal catheter.

Twenty mothers who had requested regional analgesia during labour had a 32-gauge catheter inserted into the lumbar subarachnoid space. The mean time to place the catheters was 116 s (range 55-270 s) and there were no technical difficulties. Incremental diamorphine was given, up to a maximum initial dose of 0.5 mg. Analgesia was excellent in 11 mothers, good in seven and unsatisfactory in two. The duration of initial analgesia from diamorphine was 101 min (range 30-170 min). Eight mothers were able to move about during the first stage, with effective analgesia. Side effects were common: 15 mothers had pruritus, 15 had nausea or vomiting, and eight had mild sedation. No mother had a ventilatory frequency of less than 12 b.p.m. in the 12 h after the last dose of intrathecal diamorphine. Intrathecal 0.5% bupivacaine was given to 16 mothers in the first stage because the analgesia after a top-up with diamorphine became insufficient later in the labour. Fifteen mothers were pain free after bupivacaine; there was one failure. The initial effective dose of bupivacaine was between 0.25 ml and 2 ml. The maximum height of the block after bupivacaine was T9, and there was no hypotension. Nine mothers were given hyperbaric 0.5% bupivacaine 1-2 ml during the second stage; all were pain free for the procedure. The maximum force needed to withdraw the catheters was 700 g; and all catheters were removed intact. There were no post-spinal headaches.

Adult↗
PubMed1991

Comparison of incremental spinal anesthesia using a 32-gauge catheter with extradural anaesthesia for elective caesarean section.

Forty-three mothers who had requested regional anaesthesia for elective Caesarean section were allocated randomly to receive either extradural anaesthesia with pH-adjusted 2% lignocaine with 1/200,000 adrenaline, or incremental spinal anaesthesia using a 32-gauge catheter with 0.5% plain bupivacaine. Increments of lignocaine or bupivacaine were given with the aim of achieving a block from T4 to S5. The spinal catheter was quicker to place (median 3 min, range 1-45 min, compared with median 10 min, range 1.5-50 min) and spinal anaesthesia was quicker to establish (median 20 min, range 10-46 min compared with median 48 min, range 15-59 min) compared with the extradural technique. The maximum height of the spinal block was significantly higher (median T3-4, range T5-T3) than the extradural group (median T5, range T6-T3). The total dose of intrathecal 0.5% bupivacaine was unpredictable, with a mean dose of 2.7 ml and a range between 1.5 ml and 7.4 ml. Haemodynamic stability and the quality of the block were similar between the groups. There were two mild spinal-headaches in the spinal group. All the spinal catheters were removed intact.

Anesthesia, Epidural↗
PubMed1991

Incremental spinal anaesthesia using a 32-gauge catheter.

Incremental spinal anaesthesia using a 32-gauge intrathecal catheter was studied in 13 males scheduled for transurethral resection of the prostate or repair of inguinal hernia. The spinal technique failed in four patients. Dose-response curves were obtained in the remaining nine patients using increments of 0.5% plain bupivacaine. The spinal block was extended safely and reliably without cardiovascular instability. No patient had any postoperative headache and all catheters were removed intact.

Aged↗
PubMed1990

Psychomotor recovery after three methods of sedation during spinal anaesthesia.

In a double-blinded study, we have investigated psychomotor recovery after three sedation schemes during spinal anaesthesia for transurethral resection of prostate. Thirty-nine patients were allocated randomly to receive i.v. midazolam only, i.v. midazolam with antagonism by flumazenil or an infusion of propofol. The psychomotor tests were of long and short term memory, critical flicker fusion threshold, attention and concentration, cognition, mental arithmetic, and sedation and anxiety levels, and were performed before operation and at 30 min, 60 min, 2 h and 24 h after operation. Free recall of a picture learning task was the most sensitive test, showing a significant impairment in all groups, persisting for more than 2 h. Propofol was associated with the most rapid recovery and least impairment compared with preoperative baseline. Performance improved in all the tests after antagonism with flumazenil, but was still significantly impaired compared with baseline in tests of picture recall and letter deletion. Significant decreases in performance in all tests were detected 1 h after flumazenil. No increase in anxiety was recorded after flumazenil. We conclude that infusion of propofol is the technique with the most rapid recovery, while only brief and incomplete antagonism of the effects of midazolam may be expected with flumazenil.

Aged↗
PubMed1989

Alfentanil used to supplement propofol infusions for oesophagoscopy and bronchoscopy.

This randomised double-blinded study compared the cardiovascular stability and rate of recovery when propofol infusions with or without alfentanil were used to provide anaesthesia for rigid oesophagoscopy and (or) bronchoscopy. Forty-six patients were allocated randomly to receive either alfentanil 10 micrograms/kg or saline just before a rapid sequence induction with propofol. Suxamethonium 1 mg/kg was given and infusions of suxamethonium 10 mg/minute and propofol (10 mg/kg/hour for 10 minutes, 8 mg/kg/hour for 10 minutes and then 6 mg/kg/hour thereafter) were started. There were 23 patients in each group with no significant demographic differences between the groups. A significantly mean lower induction dose of propofol was needed in the alfentanil group (1.7 mg/kg compared to 2.2 mg/kg). Cardiovascular measurements were made on the ward pre-operatively, just before induction, just after induction, just after intubation, and at 3-minute intervals thereafter. Arterial pressure was significantly lower during the procedure in the patients who received alfentanil and there was a significant incidence of hypotension. There was no significant difference between the groups in respect of heart rate, with a significant increase in both groups just after intubation compared to the baseline values. Recovery from anaesthesia was assessed using the critical flicker fusion threshold. No differences were found between the groups and patients in both groups had returned to baseline values by 60 minutes. No patient had any recall of intra-operative events, and there were no other adverse effects of any significance.

Adjuvants, Anesthesia↗