Biomedical subjects
Publications and source records attributed to J Andrzejowski.
We report an unusual complication of percutaneous dilatational tracheostomy, in which the guide wire became lodged in the bronchial tree. The assistance of an expert bronchoscopist resulted in successful removal of a fractured J wire with no adverse sequelae for the patient. A subsequent incident has given insight into the mechanism of damage to the guide wire.
We studied 133, ASA I or II children, aged 5-12 years undergoing general anaesthesia for simple dental extractions. Induction and maintenance of anaesthesia were achieved using sevoflurane in nitrous oxide and oxygen. At the end of surgery, patients had swabs soaked in a trial solution placed over the exposed teeth sockets. The bupivacaine group had swabs soaked in bupivacaine 0.25% with epinephrine 1:200 000, the saline group had swabs soaked in saline. Pain scores were recorded on a 4-point scale as follows: 0 = I don't hurt at all; 1 = I hurt a bit; 2 = I hurt a lot; 3 = I hurt the most. Nurse pain assessments and the patient's own scores were recorded at 15 and 30 min following recovery from anaesthesia. The median pain scores (2 at 15 min and 1 at 30 min postoperatively) were the same in both groups.
The Laryngotracheal Instillation of Topical Anaesthetic (LITA) tracheal tube has an additional pilot tube through which local anaesthetic can be instilled into the larynx via 10 small holes above and below the cuff We studied 40 patients undergoing supratentorial craniotomy. They were premedicated with two oral doses of propranolol 1 mg.kg(-1). The anaesthetic consisted of infusions of remifentanil, propofol and vecuronium. On insertion of the first skin clip at the end of surgery, 5 ml of either saline or 2% lidocaine was injected into the appropriate lumen of the tracheal tube. There was no difference between the groups in the degree of coughing or the haemodynamic response to tracheal extubation.
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The 'New Deal' restrictions on junior doctors' hours have major implications for the staffing of anaesthetic departments and the provision of adequate training. The results of a national postal survey demonstrate a decline in traditional on-call arrangements, especially in hard-pressed work sectors such as intensive care. A substantial number of anaesthetic departments have still completely to satisfy the hours restrictions in many work sectors. Many departments experience recruitment difficulties and express concern about both service and training issues.
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Eight patients were given a propofol infusion until they no longer responded to loud verbal stimuli, a sedation score of two (modified Observer Assessment of Alertness and Sedation Scale). After receiving 15 microg of intravenous epinephrine, changes in sedation score and bispectral index (BIS) were observed. Mean pulse rate increased from 68 to 96 (SD 10) beat.min-1, mean blood pressure increased from 107/60 (SD 10/8) mmHg to 140/70 (SD 27/14) mmHg, and mean BIS level rose from 63 to 76 (p < 0.005). Sedation scores increased in six of the eight patients. Exogenous catecholamines seem to have an arousal effect on lightly anaesthetised patients. This could be due to changes in neurotransmitter levels in the brain, or due to the effects consequent on increased cardiac output.
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UNLABELLED: How does physiological sleep affect the Bispectral Index (BIS)? We collected electroencephalographic (EEG) data from five subjects during the early part of the night, comparing the changes in the BIS with the conventional EEG stages of sleep. We found that the BIS was a consistent marker of depth of sleep. Light sleep occurred at BIS values of 75-90, slow-wave sleep occurred at BIS values of 20-70, and rapid eye movement sleep occurred at BIS values of 75-92. The effects of natural sleep on the BIS seem to be similar to the effects of general anesthesia on the BIS. The BIS may have a role in monitoring depth of sleep. IMPLICATIONS: Electroencephalographic data were collected from five subjects during sleep. We found that the Bispectral Index decreased during increasing depth of sleep in a fashion very similar to the decrease in Bispectral Index that occurs during general anesthesia. This study further highlights the electroencephalographic similarities of states of sleep and general anesthesia.
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OBJECTIVE: This study was carried out to examine the effectiveness of topically applied bupivacaine 0.25% with adrenaline 1:200,000, for post-operative analgesia in children undergoing dental extractions under general anaesthesia. DESIGN: Randomised double blind study in a single centre. SETTING: An outpatient dental clinic in a district general hospital, in England, in 1997. SUBJECTS AND METHODS: Subjects were selected from children of age 7-15 years having six or less extractions, and randomised using the closed envelope technique. INTERVENTIONS: The local anaesthetic used was bupivacaine 0.25% with adrenaline 1:200,000. MAIN OUTCOME MEASURES: Children were asked on waking from the anaesthetic whether they had pain or not. Pain was reassessed five and ten minutes post application of swabs to determine any changes in pain. RESULTS: Forty-eight children were recruited, of these 18 had no pain post-operatively and 6 were withdrawn due to a lack of cooperation. Twelve children were randomised to each group. There were 6 boys and 6 girls in the bupivacaine group (age 7-15 years), and 4 boys and 8 girls in the saline group. Bupivacaine 0.25% with adrenaline soaked swabs resulted in a significant reduction in pain in 10 children at 10 minutes (P = 0.01). CONCLUSION: Bupivacaine 0.25% with adrenaline 1:200,000, on application to exposed sockets is a simple technique that may provide useful post-operative analgesia.
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