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J A Munro

Publications and source records attributed to J A Munro.

11 recordsLinked to original sources
PubMed2001

Fast-track cardiac anaesthesia in the elderly: effect of two different anaesthetic techniques on mental recovery.

Elderly patients may be considered for 'fast-track' cardiac anaesthesia, but can suffer psychological complications and slow recovery of mental function after surgery, which can interfere with recovery. Reduced metabolism and changed distribution of anaesthetic and sedative agents can cause poor recovery. We made a prospective randomized comparison of mental function, haemodynamic stability and extubation and discharge times in elderly patients (65-79 yr) receiving two premedication, anaesthetic and sedative techniques. Patients received either propofol (n=39) (fentanyl 10-15 microg kg(-1) and propofol 2-6 mg kg(-1) intraoperatively and a propofol infusion for 3 h postoperatively) or premedication with lorazepam followed by midazolam for anaesthesia (n=39) (fentanyl 10-15 microg kg(-1) and midazolam 0.05-0.075 mg kg(-1) intraoperatively and a midazolam infusion for 3 h postoperatively). Impairment of mental function was noted in 41% of patients in the propofol group and 83% in the lorazepam and midazolam group (P=0.001) 18 h after extubation. Patients in the propofol group were extubated earlier [1.4 (SD 0.6) vs 1.9 (0.8) h, P=0.02]; and reached standard intensive care unit discharge criteria [7.6 (4.6) vs 14.2 (13) h, P=0.02] and hospital discharge criteria [4.3 (1.0) vs 4.9 (1.1) days, P=0.04) sooner than patients in the lorazepam and midazolam group, but actual discharge times did not differ between the groups. Haemodynamic values were stable in both groups.

Aged↗
PubMed1998

Intraoperative awareness in fast-track cardiac anesthesia.

BACKGROUND: Fast-track cardiac anesthesia, using low-dose narcotics combined with short-acting anesthetic and sedative agents, facilitates early tracheal extubation after cardiac surgery. The incidence of awareness with this anesthetic technique has not been investigated previously. The purpose of this study was to prospectively investigate the incidence of intraoperative awareness with explicit memory of events during fast-track cardiac anesthesia. METHODS: Data were collected prospectively over a 4-month period from 617 consecutive adult patients undergoing cardiac surgery at a university hospital. All patients received a fast-track cardiac anesthetic regimen. Patients underwent a structured interview by a research nurse 18 h after extubation. A standard set of questions was asked during this interview to determine if the patient had explicit memory of any event from induction of anesthesia to recovery of consciousness. RESULTS: Nine patients did not complete a postoperative interview because of death (n = 7) or postoperative confusion (n = 2). The last memory before surgery reported in 420 (69.1%) patients was waiting in the holding area at the operating suite, and in the remaining 188 (30.9%) patients it was lying on the operating table before induction of anesthesia. Two patients (0.3%) had explicit memory of intraoperative events. One of the two patients also had explicit memory of pain. Neither patient reported adverse psychological sequelae. CONCLUSIONS: The authors report an incidence of awareness in fast-track cardiac anesthesia of 0.3%. This is the lowest incidence of awareness currently reported during cardiac surgery. This low incidence of awareness may be related to the use of a balanced anesthetic technique involving the continuous administration of volatile (isoflurane) or intravenous (propofol) anesthetic agents before, during, and after cardiopulmonary bypass.

Anesthesia↗
PubMed1991

Study of the management of chlamydial cervicitis in general practice.

The role of the general practitioner in the detection and management of Chlamydia trachomatis infections of the cervix is uncertain. The management by the primary care team of women presenting with lower genital tract symptoms has therefore been studied in one suburban practice. Of 386 women presenting with lower genital tract symptoms over the two year study period 25 (6%) had a positive cervical MicroTrak (Syva) test for Chlamydia trachomatis. Twenty four of these chlamydia positive patients were given their results and treatment by the practice. Twenty two women returned for a follow-up MicroTrak test after treatment and two of these patients (9%) had a positive test following treatment. A review of the patients' notes indicated that contact tracing had been discussed with 22 of the 25 chlamydia positive patients. The results of the management of chlamydial cervicitis by this primary health care team are acceptable when compared with studies from hospital clinics. Provided the primary care team has access to facilities for the diagnosis of C trachomatis and can follow up non-attenders to ensure they receive their results, provide information about contact tracing and follow up positive patients then chlamydial cervicitis can be managed in general practice.

Adolescent↗
PubMed1987

Factors influencing circulating OKT8 cell phenotypes in patients with multiple sclerosis.

Peripheral blood OKT8 cell phenotypes were correlated with measurements of plasma cortisol and serological evidence for exposure to 15 infectious agents, in longitudinal studies involving 13 patients with multiple sclerosis, 13 of their siblings, nine spouses and 13 unrelated controls; 44/48 individuals were HLA typed. Neither circadian rhythms, nor exposure to any one infectious agent accounted for the serial changes in OKT8 cells but there was an association between the presence of HLA-DR2 and periodic reductions in OKT8 cells irrespective of clinical status. Taken with previously reported serial observations in patients and cohabiting relatives, this finding provides indirect evidence for an interplay between environmental and genetic factors in determining OKT8 cell phenotypes in multiple sclerosis.

Antibodies↗
PubMed1986

Contribution of Gardnerella vaginalis to vaginitis in a general practice.

In a study of 154 adult women who presented to their general practitioner with vaginal symptoms 30 (20%) had Gardnerella vaginalis on its own and 51 (33%) had G vaginalis in combination with anaerobes or known pathogens. Thirty one (20%) patients were culture negative. Those who were culture negative had fewer symptoms and signs of vaginitis than those with G vaginalis alone or G vaginalis plus anaerobes. Those with known pathogens had more symptoms and signs than those with G vaginalis alone or G vaginalis plus anaerobes. Those with known pathogens plus G vaginalis had the most severe signs and symptoms of vaginitis. It is concluded that G vaginalis can cause vaginitis on its own, and it makes vaginitis worse when present with other organisms. G vaginalis was also found in 30 (21%) of the 138 control patients who, although they presented "asymptomatically," had worse signs than control patients without G vaginalis. It seems that G vaginalis can occur in a spectrum ranging from the uncomplaining patient to those with severe vaginitis.

Adolescent↗
PubMed1978

The effects of immunisation upon the natural history of pertussis. A family study in the Cardiff area.

During an outbreak of pertussis in the Cardiff area in 1974, 229 children with the disease were studied to assess the effect of immunisation upon its natural history and severity. The typical clinical features of pertussis, such as paroxysmal cough, whooping, vomiting, cyanosis, and irregular breathing, were less prevalent in both the immunised and the older children. Immunisation is the main factor in protecting against complications such as fits; and, together with older age, it protects against hospitalisation. Nevertheless, pertussis today can be just as severe as it was 40 years ago, and the vaccine remains the major factor ameliorating its natural history. The immunisation programme needs more active support by all child health workers.

Adolescent↗