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Biomedical subjects

J A Thornton

Publications and source records attributed to J A Thornton.

At least 19 recordsLinked to original sources

Rhinal cortex removal produces amnesia for preoperatively learned discrimination problems but fails to disrupt postoperative acquisition and retention in rhesus monkeys.

To test whether the rhinal cortex (i.e., entorhinal and perirhinal cortex) plays a time-limited role in information storage, eight rhesus monkeys were trained to criterion on two sets of 60 object discrimination problems, one set at each of two different time periods separated by 15 weeks. After the monkeys had learned both sets, two groups balanced for preoperative acquisition rates were formed. One group received bilateral ablation of the rhinal cortex (n = 4), and the other was retained as an unoperated control group (n = 4). After a 2 week rest period, monkeys were assessed for retention of the object discrimination problems. Retention was significantly poorer in monkeys with removals of the rhinal cortex relative to the controls (68 vs 91%). Although both groups showed slightly better retention of problems from the more recently learned set, there was no evidence of a differential effect of the cortical removal across sets (i.e., no temporal gradient). In addition, the monkeys with rhinal cortex lesions subsequently learned three new sets of 10 object discrimination problems as quickly as the controls did, thus ruling out the possibility of a gross impairment in visual perception or discrimination abilities. Furthermore, they retained these postoperatively learned object discriminations as well as the controls did. The findings indicate that the rhinal cortex is critical for the storage and/or retrieval of object discrimination problems that were learned up to 16 weeks before rhinal cortex ablation; however, in the absence of the rhinal cortex, efficient learning and retention of new discrimination problems can still occur.

Amnesia, Retrograde

Ventilatory effects of isoflurane: a comparison with halothane in a draw-over system.

Halothane and isoflurane were studied using a draw-over anaesthetic system in two groups each of 25 patients to compare the ventilatory effects of the two agents in field anaesthesia. Respiratory variables were measured and it was confirmed that isoflurane is a more potent respiratory depressant than halothane, but satisfactory anaesthesia for short procedures was possible.

Anesthesia, Inhalation

A comparison of alfentanil requirements in European and Asian patients during general anaesthesia.

Alfentanil requirements were compared in thirty-six Asian and forty-three European patients during general anaesthesia with muscle relaxants. Alfentanil infusion at 5 micrograms/kg/min was started immediately after induction with thiopentone and alcuronium. The infusion rate was reduced to 0.5 microgram/kg/min after ten minutes. An incremental dose of 5 micrograms/kg/min for five minutes was given on each occasion when anaesthesia was clinically judged to be inadequate. Recovery parameters were recorded. Pharmacokinetics were also studied in five Europeans, four Chinese and four Nepalese. The dosage of alfentanil required was comparable in both Asian and European patients, but recovery was slower in the Asian patients. The elimination half-life in the Chinese and the Nepalese were both significantly shorter than that of the Europeans (P less than 0.05), but at the time of recovery of spontaneous ventilation, the mean plasma concentrations were not significantly different.

Adolescent

Midazolam in conservative dentistry. A cross-over trial.

In a double-blind trial, 50 patients were randomly allocated to receive up to 0.29 mg/kg diazepam (Valium 5 mg/ml) or 0.14 mg/kg of midazolam (midazolam hydrochloride 5 mg/ml) intravenously at a first session of conservative dentistry, the alternative being administered at the second session. Good operating conditions were reported under each sedative and no important physiological differences were observed. Most patients failed to return to 'street fitness' 30 minutes after either session of treatment. Previous reports of reduced incidence of venous thrombophlebitis with midazolam were not convincingly confirmed in this trial, but data quality was poor. For about half the patients, the amnesic effect was stronger following midazolam.

Adolescent

Assessment of the role of an immunofluorescent terminal deoxynucleotidyl transferase kit.

The laboratory use of a commercial kit for the immunofluorescent measurement of terminal deoxynucleotidyl transferase (BRL Terminal Deoxynucleotidyl Transferase Immunofluorescent Assay System) has been investigated. The precision of the assay system with stored patient material and its performance with regard to ease of microscopic examination were assessed. The intensity of the fluorescence obtained was found to vary. However, the precision of the assay system on fixed slides stored at -30 degrees C was satisfactory; the method simple, and results obtainable in a relatively short space of time.

Bone Marrow

Anaesthetic deaths.

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Anesthesia, Dental

Total intravenous anaesthesia with etomidate-fentanyl. Use in general and gynaecological surgery.

A total intravenous anaesthetic technique using etomidate, fentanyl and neuromuscular blocking drugs with artificial ventilation of the lungs has been used in 90 patients undergoing elective general and gynaecological surgery. A two-step schedule was used, based on a pharmacokinetic model for rapidly eliminated, intravenously administered drugs. Etomidate 100 micrograms/kg/minute with fentanyl 1 microgram/kg/minute were given for 10 minutes, followed by a maintenance dose at a rate of one-tenth this amount. Concurrent evaluation of the technique led to variations in the adjuvant drugs used (atropine, droperidol and neuromuscular blocking agent). The basic dose schedule provided adequate surgical anaesthesia for 76% of patients (although dose adjustments were used in the remainder), with recovery times of 10 minutes or less in 57% of patients. No further opiate analgesia was needed in 40% of patients postoperatively. Those patients given atropine intravenously prior to induction had a significantly lower incidence of nausea and vomiting postoperatively.

Adjuvants, Anesthesia

Evaluation of a new range of air drawover vaporizers. The 'PAC' series--laboratory and 'field' studies.

The 'Ether Pac' and 'Fluo Pac' temperature compensated vaporizers have been evaluated in the laboratory and the 'field'. Rigorous testing has demonstrated that these vaporizers are robust and reliable. Shaking, tilting and overturning do not significantly affect their performance. Both vaporizers deliver lower concentrations of the vapour than the setting on the vaporizers at low tidal volumes (100 ml). The 'Ether Pac' vaporizer output declines progressively with ambient temperatures below 23 degrees C and a similar result occurs with the 'Fluo Pac' at temperatures below 20 degrees C. Clinical trials in Nepal, Kenya, Burma and the UK have demonstrated that, when halothane is used, oxygen enrichment is necessary during spontaneous and controlled ventilation. When ether is used with controlled ventilation oxygen enrichment is probably not necessary even with ambient pressures as low as 619 mmHg.

Adolescent

Midazolam--does it cause resedation?

The objective of this double blind study was to compare the sedation following the intravenous injections of midazolam in three dose levels (0.07, 0.10 and 0.15 mg/kg), and to assess the time taken after each dose to return to street fitness. Recovery was monitored by measurement of reaction time. The mean results for each dose were compared against placebo and each other using the Student's t-test. All doses gave a significant (p less than 0.05) lengthening of reaction time compared to placebo. The two highest doses gave similar results when compared to 0.07 mg/kg, but not when compared to each other. Reaction times always returned to control values within 3 hours of injection. The Deletion of Ps test was also employed. A significant correlation was found between the results of reaction time testing and the Deletion of Ps test.

Adolescent

Anaesthetic deaths.

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Anesthesia, Dental

Immunological and non-immunological mechanisms involved in adverse reactions to drugs.

This communication reviews the mechanisms involved in anaphylactic and anaphylactoid reactions to intravenous drugs used in anaesthesia. Although the mechanisms involved are pertinent to other drugs and substances used in clinical practice, the use of the intravenous route makes this a particularly worrying problem in anaesthetic practice. Despite the similarity of the clinical manifestations to those expected from immediate immunological hypersensitivity (anaphylaxis), relatively few reactions involve antibodies. Instead, a variety of mechanisms occur where activation of the blood inflammatory response systems, particularly complement, may be either primary or secondary to activation of the coagulation or fibrinolytic cascades of the blood clotting mechanisms. Immediate anaphylactoid reactions, manifest in the release of vasoactive substances such as histamine, may therefore pose very minor problems compared with coagulation problems arising in the peri- and post-operative period. It is important to discover the mechanism of all adverse reactions not only if these are to be avoided in the reactants in the future but also because of the necessity for devising suitable prophylactic and therapeutic measures for general use. The practical problems of such investigations are explored with particular reference to the laboratory investigation of subclinical reactions in terms of plasma histamine release and changes in blood leucocyte distribution.

Adult

Continuous thoracic epidural fentanyl. A comparison of epidural fentanyl with intramuscular papaveretum for postoperative pain.

A prospective open trial was conducted to compare the analgesic and side-effects of continuously infused fentanyl into the thoracic epidural space with those of intramuscular papaveretum given 4 hourly as required. It was demonstrated that during the first 24 hours after upper abdominal surgery thoracic epidural fentanyl produced better analgesia with less sedation than intramuscular papaveretum. However, the epidural group suffered more nausea. Likewise, postoperative respiratory function tests were statistically significantly better in those patients who received epidural fentanyl. Despite a significantly greater volume of nasogastric aspirate during the period of study, the epidural fentanyl group also had a significantly greater urine output than did the patients receiving papaveretum. Hypotension and respiratory depression were not problems, but pruritus occurred in two patients given fentanyl. It is concluded that epidural fentanyl delivered by continuous infusion offers significant advantages over a conventional intramuscular narcotic regime.

Adult

Supernumerary senior house offices in anaesthesia: a review of a regional training scheme, 1962-1972.

The Sheffield Regional Hospital Board, which became the Trent Regional Health Authority in 1974, initiated a scheme for training of Senior House Officers in anaesthesia in 1962; between 1962 and 1972, 73 graduates passed through the scheme of whom 29 (40%)* held consultant posts at the time of the review (mid 1979), another 8 (11%)* were senior registrars and on the way to consultant status. None of the 16 overseas graduates had achieved consultant status although one was a senior registrar. Twenty-six (35-6%)* of the 73 doctors (15(20-5%)* United Kingdom or Republic of Ireland graduates and 11 (15-1%)* from overseas) are thought to have left the practice of anaesthesia although some of these were not traced and may indeed be practising, and some of the females have indicated an intention to return to the specialty when their children are older.

Anesthesiology