PubMed Health⌕ Search

Biomedical subjects

J A Wildsmith

Publications and source records attributed to J A Wildsmith.

At least 19 recordsLinked to original sources
PubMed1998

Alleged allergy to local anaesthetic drugs.

OBJECTIVE: To identify the true nature of an acute reaction in 25 patients initially diagnosed as allergic to local anaesthetic drugs. SETTING: University General and Dental Hospitals. INTERVENTIONS: Detailed review of each patient's previous exposure to local anaesthetic drugs and of the history of the acute event was followed up with challenge testing by intradermal injection. RESULTS: One patient was subsequently found to be genuinely allergic to a local anaesthetic drug of the amide type. A wide range of conditions had actually precipitated the other adverse reactions, but all could be classified under three major headings: an immunological condition to a different antigen; a manifestation of anxiety; or an iatrogenic problem. CONCLUSION: Local anaesthetic allergy is rare, but does occur. All reactions to local anaesthetic drugs must be assessed carefully and specialist referral may be appropriate.

Acute Disease↗
PubMed1998

Comparison of continuous and intermittent administration of extradural bupivacaine for analgesia after lower abdominal surgery.

We have compared intermittent bolus and continuous infusion of extradural local anaesthetic for pain relief in a randomized, double-blind study of 48 patients who underwent major abdominal gynaecological surgery. Each patient received 5 ml of 0.375% bupivacaine hourly, either as a bolus over 5 min or as a constant infusion. Patients who received the intermittent administration technique maintained a more extensive sensory block, reported marginally better analgesia and had a lower requirement for rescue medication. The intermittent bolus technique was not associated with an increase in side effects.

Adult↗
PubMed1997

Anaphylaxis associated with, but not caused by, extradural bupivacaine.

Identifying anaphylaxis and determining its cause during anaesthesia can be very difficult. We describe a patient who suffered a life-threatening reaction which was diagnosed originally as being caused by bupivacaine. Subsequent investigation and enquiry showed that this was not so and suggested latex as the likely true cause.

Adult↗
PubMed1995

Cerebral oximetry: a useful monitor during carotid artery surgery.

Cerebral oximetry was evaluated as a monitor of oxygenation during carotid endarterectomy in 22 patients. The oximeter was a reliable continuous monitor, identifying changes in cerebral oxygenation during episodes of hypotension and after arterial occlusion. Changes in oxygenation correlated well with the surgical assessment of backbleeding after arterial clamping, but less well with other methods which are used to make a decision on insertion of an arterial shunt. There was no correlation between internal carotid artery stump pressure and change in cerebral oxygenation after application of the arterial cross clamp. However, cerebral oxygenation correlated weakly with the change in middle cerebral artery velocity as measured by transcranial Doppler ultrasonography (r = 0.49, p < 0.02).

Blood Flow Velocity↗