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Biomedical subjects

J G Todd

Publications and source records attributed to J G Todd.

18 recordsLinked to original sources
PubMed2002

Analgesia for pelvic brachytherapy.

Pelvic brachytherapy presents the anaesthetist with numerous challenges. Patients vary from highly distressed young adults, to the elderly with coincidental disease severe enough to preclude surgery. The painful radioactive implants remain in place for a number of days. Treatment in isolated rooms reduces radiation exposure to staff, but makes close postoperative monitoring difficult, so the analgesic technique should involve minimum risk to the patient. Although there is very little published evidence of specific analgesic techniques in this area, knowledge of these problems allows the anaesthetist to select appropriate systemic analgesics and regional blocks to provide safe and effective pain relief.

Analgesia↗
PubMed1999

A political history of the Indian Health Service.

One of the few bright spots to emerge from the history of relations between American Indians and the federal government is the remarkable record of the Indian Health Service (IHS). The IHS has raised the health status of Indians to approximate that of most other Americans, a striking achievement in the light of the poverty and stark living conditions experienced by this population. The gains occurred in spite of chronically low funding and can be attributed to the combination of vision, stubbornness, and political savvy of the agency's physician directors and the support of a handful of tribal leaders and powerful allies in the Congress and the White House. Despite the agency's imperfections and the sizeable health problems that still exist among American Indians and Alaskan Natives, the IHS is an example of one federal program that has worked.

Health Promotion↗
PubMed1998

A prospective evaluation of the feasibility of day-case microlaryngeal surgery.

An increasing number of surgical procedures are being performed on a day-case basis. In the UK otolaryngologists have been reluctant to introduce same day discharge in microlaryngeal surgery (MLS). The reason for this is the perceived risk to the airway from bleeding and oedema after MLS. The aim of this study was to investigate the feasibility of establishing a same day discharge service for MLS patients. One hundred consecutive patients under the care of one consultant otolaryngologist were recruited. A clinical street-fit assessment and objective measures of peak expiratory flow rate (PEFR) and oxygen saturation (SaO2) were recorded pre- and post-operatively. Results indicate that the PEFR and SaO2 did not change significantly during the course of the study. The street-fit criteria for discharge were satisfied in 80 per cent of patients following surgery. By combining the ASA score (American Society of Anaesthesiologists) with street-fitness 63 per cent of our patients were eligible for same day discharge.

Adult↗
PubMed1992

Evaluation of closed loop control of arterial pressure during hypotensive anaesthesia for local resection of intraocular melanoma.

We have studied 20 patients undergoing local resection of intraocular melanoma during hypotensive anaesthesia, allocated randomly to receive either manual control by an experienced anaesthetist or closed-loop computer control of an infusion of a 5:1 mixture of trimetaphan camsylate (TMP) and sodium nitroprusside (SNP). There were no significant differences in the smallest systolic and diastolic arterial pressures obtained, heart rate or infusion requirements between the two groups, but the duration of both the infusion and the operation were significantly longer in the computer-controlled group (P < 0.05). The quality of control of arterial pressure was assessed by the percentage of time spent at pressures greater and less than the prescribed target values, and was satisfactory in both groups during the critical period of profound hypotension. We conclude that the computer-controlled infusion performed satisfactorily during profound hypotension compared with an experienced anaesthetist.

Adult↗
PubMed1992

A comparison of two approaches to sciatic nerve block.

This study compared the posterior and popliteal fossa approaches for sciatic nerve block. Patients scheduled to undergo foot surgery were allocated randomly into one of two groups: group A (n = 20) received sciatic nerve block via the posterior approach and group B (n = 20) received a block using the popliteal fossa approach. All blocks were performed with the aid of a peripheral nerve stimulator and alkalinised 0.5% bupivacaine with 1 in 200,000 adrenaline was injected in a dose of 2 mg.kg-1. Nineteen of 20 blocks in group A were successful compared with nine of 20 in group B (p less than 0.01). There was no significant difference between the groups in respect of time to onset or duration of block. Patients in group B reported less discomfort during performance of the sciatic nerve block but required supplementary nerve blocks more frequently. We recommend the use of the posterior approach for sciatic nerve block.

Adult↗
PubMed1991

Comparison of the Finapres and direct arterial pressure monitoring during profound hypotensive anaesthesia.

The Finapres was compared with direct intraarterial pressure monitoring in 10 patients undergoing local resection of choroidal melanoma, an operation that requires a period of profound hypotension. Good agreement was recorded for systolic arterial pressure and heart rate over a range of pressures. However, agreement of mean and diastolic pressures was poor, with the Finapres tending to overestimate these values. In cases requiring profound hypotension, direct arterial pressure monitoring remains the method of choice.

Anesthesia, General↗
PubMed1989

Outpatient paediatric dental anaesthesia. A comparison of halothane, enflurane and isoflurane.

One hundred and fifty unpremedicated children who presented for dental extractions were anaesthetised with nitrous oxide and halothane, enflurane or isoflurane. Ventricular arrhythmias occurred only in the halothane group (14%). Respiratory problems and desaturation were significantly more common in the isoflurane group. Induction times differed significantly between the groups halothane less than enflurane less than isoflurane, while recovery time and induction to recovery time were significantly shorter in the enflurane group. We suggest that enflurane is the most suitable agent for anaesthetising these patients.

Ambulatory Surgical Procedures↗
PubMed1989

Alkalinisation of bupivacaine for sciatic nerve blockade.

This double-blind study investigates the effect of pH adjustment of bupivacaine 0.5% with adrenaline 1:200,000 on block latency, duration of analgesia and systemic absorption of local anaesthetic after sciatic nerve blockade. Twenty-four adult patients were randomly allocated into one of two groups: Group A (n = 12) received bupivacaine with adrenaline 1:200,000 (pH 3.9) 2 mg/kg, while Group B (n = 12) received alkalinised bupivacaine with adrenaline 1:200,000 (pH 6.4) 2 mg/kg. Increasing the pH of the local anaesthetic solution significantly reduced block latency from 25 minutes in Group A to 12.5 minutes in Group B (p less than 0.001) and prolonged the duration of useful analgesia from 14.1 hours to 18.3 hours (p less than 0.001). There was no significant difference in plasma bupivacaine levels between the two groups. The results indicate that alkalinisation of bupivacaine reduces time to onset and prolongs the duration of useful analgesia when used for sciatic nerve blockade, without significantly increasing systemic absorption.

Anesthesia, Local↗
PubMed1989

Gastric emptying after head injury.

Gastric emptying was measured in patients after head injury and compared with that of healthy volunteers using the rate of paracetamol absorption as an indicator of gastric emptying rate. There was a trend towards slower gastric emptying in the head injured patients, but the differences were not statistically significant.

Acetaminophen↗
PubMed1986

Effect of meptazinol on drug absorption and gastric emptying.

The rate of paracetamol absorption after oral administration was used as an indirect estimate of the rate of gastric emptying in 24 patients before minor surgery. Patients who received 10 mg morphine or 100 mg meptazinol i.m. had significantly delayed absorption as shown by a lower peak concentration and a delayed time to peak. The mean AUC at 90 min was 1,590, 642 and 159 micrograms min ml-1 after saline, morphine and meptazinol respectively. Meptazinol delayed paracetamol absorption more than morphine.

Acetaminophen↗
PubMed1985

Fentanyl by constant rate i.v. infusion for postoperative analgesia.

Fentanyl by continuous i.v. infusion (1.5 microgram kg-1 min-1 or 0.5 microgram kg-1 min-1) was compared with placebo infusion as an analgesic regimen for 24 h after hysterectomy. The drugs were infused using a new disposable device which required no external power source. All patients were allowed morphine i.m. if they experienced pain. Patients in the higher dose fentanyl group demanded less i.m. morphine and had better pain relief after operation, without important respiratory depression.

Female↗
PubMed1983

Effect of premedication on drug absorption and gastric emptying.

The rate of paracetamol absorption after oral administration was used as a model of drug absorption and as an indirect measure of the rate of gastric emptying in 37 patients awaiting elective general surgery after different premedications. After saline (control) and diazepam, paracetamol absorption was normal but after morphine or nefopam, absorption was delayed markedly, presumably as a result of delayed gastric emptying. After naloxone there was a small but insignificant delay.

Acetaminophen↗