Biomedical subjects
Publications and source records attributed to J H Raphael.
Tracheobronchomegaly is a rare condition in which anaesthetic experience is limited. Patients with tracheobronchomegaly are at risk of large airway collapse and obstruction, aspiration pneumonitis and tracheal trauma following airway instrumentation. We describe our anaesthetic technique and problems encountered during nephrectomy in a patient with this condition.
A high frequency oscillator and its interface with the Siemens 900C ventilator form a combined high frequency oscillator and intermittent positive pressure ventilator. This combined high frequency ventilator is designed for use in selected cases of refractory hypoxaemia.
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We investigated the hypothesis that cervical collars might compress the internal jugular veins and raise intracranial pressure in head-injured patients. In a randomised, single-blind, crossover study of nine patients scheduled for elective spinal anaesthesia the cerebrospinal fluid pressure in the lumbar subarachnoid space was measured with and without a 'Stifneck' cervical collar applied. There was a significant elevation of cerebrospinal fluid pressure in seven of the patients studied when the cervical collar was applied (p < 0.01). This preliminary study raises the possibility that immobilisation of the cervical spine with the 'Stifneck' cervical collar may, by raising the intracranial pressure, contribute to secondary neurological injury in head-injured patients in whom intracranial compliance is already reduced.
A double-blind, randomised, controlled study was undertaken to investigate the effects on injection pain and excitatory phenomena of adding thiopentone to methohexitone. One hundred and twenty unpremedicated, day-case patients received one of four induction regimens: unmodified 1% methohexitone, or a mixture of 2.5% thiopentone and 1% methohexitone in ratios of 1:1, 1:3 or 1:9 by volume. The addition of one part of thiopentone to three parts of methohexitone produced a mixture which significantly reduced the occurrence of pain and discomfort compared with methohexitone alone from 67% to 13% (p < 0.01) and reduced the occurrence of excitatory effects from 50% to 13% (p < 0.01).
In a randomized, double-blind study, we have compared the prophylactic antiemetic efficacy of ondansetron with that of metoclopramide in 123 patients undergoing general anaesthesia for day-case gynaecological laparoscopic surgery. The patients received either i.v. ondansetron 4 mg or metoclopramide 10 mg immediately before a standard anaesthetic. The number of patients with no nausea or vomiting in the ondansteron group was 50 (82%) compared with 29 (47%) in the metoclopramide group (P < 0.001). In those patients with a previous history of postoperative nausea and vomiting, nausea was less severe in those receiving ondansetron compared with those receiving metoclopramide (P < 0.05). We conclude that preoperative prophylactic administration of i.v. ondansetron was superior to metoclopramide in preventing nausea and vomiting after general anaesthesia for day-case gynaecological laparoscopic surgery.
We describe a pregnant patient with respiratory failure due to an atypical pneumonia and asthma that was successfully treated with the combination of high frequency oscillatory ventilation and intermittent positive pressure ventilation. This combined high frequency ventilatory technique is not commonly used in adults with respiratory failure and is largely contraindicated in patients with prolonged respiratory time constants such as occurs in asthma because of the risk of gas trapping. We suggest that this technique be considered in cases of respiratory failure refractory to conventional intermittent positive pressure ventilation and, that with appropriate monitoring of airways pressure, is worthy of a trial in patients with prolonged respiratory time constants.
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