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Biomedical subjects

J Derrick

Publications and source records attributed to J Derrick.

9 recordsLinked to original sources
PubMed2000

Closed loop control of anaesthesia: an assessment of the bispectral index as the target of control.

We investigated the performance of a closed-loop system for administration of general anaesthesia, using the bispectral index as a target for control. One hundred patients undergoing gynaecological or general surgery were studied. In 60 patients, anaesthesia was maintained by intravenous infusion of a propofol/alfentanil mixture. In 40, an isoflurane/nitrous oxide based technique was used. For each technique, patients were randomly allocated to receive either closed-loop or manually controlled administration of the relevant agents (propofol/alfentanil or isoflurane), with an intra-operative target bispectral index of 50 in all cases. Closed-loop and manually controlled administration of anaesthesia resulted in similar intra-operative conditions and initial recovery characteristics. During maintenance of anaesthesia, cardiovascular and electro-encephalographic variables did not differ between closed-loop and manual control groups and deviation of bispectral index from the target value was similar. Intra-operative concentrations of propofol, alfentanil and isoflurane were within normal clinical ranges. Episodes of light anaesthesia were more common in the closed-loop group for patients receiving propofol/alfentanil anaesthesia and in the manual group for patients receiving isoflurane/nitrous oxide anaesthesia. Convenience aside, the closed-loop system showed no clinical advantage over conventional, manually adjusted techniques of anaesthetic administration.

Adult↗
PubMed1999

Hematopoietic cytokine-inducible gene expression from retroviral vectors.

Retroviral vectors capable of cytokine-inducible gene expression will be useful for a number of gene therapy applications. We explored one mechanism whereby cytokine inducibility may be imparted to the retroviral U3 promoter/enhancer by utilizing the JAK-STAT signal transduction pathway that is activated by a number of hematopoietic cytokines. We used PCR mutagenesis to insert a consensus binding site for the ubiquitous transcription factor Sp1 into the Moloney murine leukemia virus U3 followed by the insertion of multimers of a STAT-binding oligonucleotide with the core sequence 5'-TTCCCGGAA. After insertion of the modified U3s into a retroviral vector expressing the luciferase reporter gene and transduction of the HepG2 cell line, luciferase expression was induced with recombinant human IFN-gamma. The level of induction reached a maximum of 9.9-fold higher than the uninduced vector when the Sp1-U3 contained four STAT oligos. When this optimal vector was compared with the wild-type and Sp1 vectors, respective values of 17.9- and 16.7-fold higher expression were achieved with IFN-gamma treatment. Retroviral vectors incorporating these cytokine-inducible U3s will be useful for gene therapy in a number of situations involving gene transfer to hematopoietic, hepatic and other cytokine-responsive cell types.

Cell Line↗
PubMed1999

The influence of baricity on the haemodynamic effects of intrathecal bupivacaine 0.5%.

This study compared the haemodynamic effects of subarachnoid block with plain bupivacaine 0.5% (dextrose-free), heavy bupivacaine 0.5% (in dextrose 8%) and a mixture of these two solutions, i.e. bupivacaine 0.5% in dextrose 4%. Thirty-six male patients, aged 55-89 years, undergoing transurethral surgery were recruited. Invasive systolic arterial and central venous pressures were recorded at 5-s intervals after the block was initiated using a computerised data-collection system. The height of sensory blockade was recorded at 5-min intervals. No preload was given and episodes of hypotension were treated with colloid (8 ml x kg(-1)) and, if this was ineffective, a metaraminol infusion. Systolic arterial and central venous pressures decreased in all three groups following block (p < 0.05). These decreases were more rapid in onset in the heavy bupivacaine group compared with plain bupivacaine group (p < 0.005). Patients in the heavy bupivacaine group also had a greater requirement for early treatment of hypotension (< 10 min) and treatment with metaraminol (p < 0.05). The onset of sensory blockade was more rapid in the heavy group compared with the mixed group, although final sensory levels were similar. The onset of haemodynamic and sensory changes are more rapid when using heavy bupivacaine intrathecally. This leads to a higher and earlier incidence of hypotension and requirement for treatment.

Aged↗
PubMed1997

Oxygen delivery, oxygen consumption, and gastric intramucosal pH are not improved by a computer-controlled, closed-loop, vecuronium infusion in severe sepsis and septic shock.

OBJECTIVE: To investigate the influence of the neuromuscular blocking agent vecuronium on oxygen delivery (DO2), oxygen consumption (VO2), oxygen extraction ratio, and gastric intramucosal pH in heavily sedated patients with severe sepsis or septic shock. DESIGN: Prospective, randomized, placebo-controlled, cross-over trial. SETTING: University hospital intensive care unit. PATIENTS: Eighteen mechanically ventilated patients with severe sepsis or septic shock. INTERVENTIONS: All patients were heavily sedated. After baseline measurement, a computer-controlled, closed-loop infusion of either vecuronium or saline was initiated and further measurements were made at 40 and 60 mins. The procedure was repeated with the alternative agent after return of neuromuscular function. MEASUREMENTS AND MAIN RESULTS: DO2, VO2, intramucosal pH were monitored using pulmonary artery catheters, a gas exchange monitor, and gastric tonometers. Changes from baseline were compared (paired t-test, p = .05). The vecuronium closed-loop infusion achieved T1 between 5% and 15% at 40 mins. There was a significant difference in the changes from baseline for static respiratory compliance in the vecuronium closed-loop infusion group compared with the saline closed-loop infusion group. There was no significant difference in the change from baseline for systemic or pulmonary vascular resistance, DO2, VO2, oxygen extraction ratio, or intramucosal pH. CONCLUSIONS: In these patients, vecuronium infusion achieved the targeted level of paralysis and improved respiratory compliance but did not alter intramucosal pH, VO2, DO2, or oxygen extraction ratios. With deep sedation, neuromuscular blockade in severe sepsis/septic shock does not significantly influence oxygen flux and should be abandoned as a routine method of improving tissue oxygenation in these patients.

Adult↗
PubMed1994

Complementary peptides that interfere with platelet aggregation and adherence.

This article describes the application of the molecular recognition hypothesis to the critically important process of fibrinogen binding to platelets, a process that is the subject of extensive and intensive basic and clinical research. The objectives of the studies summarized below were to design, synthesize, and characterize peptides that can inhibit the binding of fibrinogen and related ligands to human platelets and thereby prevent platelet aggregation, adhesion, and clot retraction. The purpose of doing this work was twofold: first, to determine whether the molecular recognition hypothesis could serve as a useful rationale for the design of peptides that can specifically inhibit the binding of fibrinogen and related ligands to platelets; and second, to use these peptides to try to learn where fibrinogen binds to the platelet fibrinogen receptor. It was hoped that the results obtained not only would provide insight into platelet function but also might provide a rationale for the design of a clinically useful anti-thrombotic agent. Although our studies are not complete, they have resulted in the design of a variety of peptides that can inhibit platelet aggregation, adhesion, and clot retraction as a consequence of specifically inhibiting the binding of fibrinogen and related ligands to the platelet fibrinogen receptor. Although none of these peptides appears to be ligand specific, one or two of them may be specific for platelets.

Amino Acid Sequence↗
PubMedDate not supplied

Developing a standard of practice while undergoing a facility merger.

While the three facilities that eventually became Centennial Medical Center in Nashville were in the process of merging, it became necessary to merge all of the nursing policies and procedures to establish one standard of practice. Many areas of nursing are not accountable to the vice president of nursing, yet she is responsible for nursing standards of care and practice. To bring it all together, the author formed a council of all the chairs of the manual revision process; this council condensed 35 manuals to 19 manuals, developed historical files on all active and inactive policies, developed a flow chart for new policy manual assignments, and developed one standard of practice for the medical center.

Decision Making, Organizational↗