Biomedical subjects
J Lumley
Publications and source records attributed to J Lumley.
Patterns of life after graduation.
The integration of work and family life is problematic for many doctors. Most of us received little help in resolving the relevant issues during our own formal education. This paper describes a series of informal meetings which were organized for the fifth-year medical students to provide information about possible patterns of work, and to encourage discussion and comment. Areas of particular concern turned out to be postgraduate training, parenting, and the dual-career family. The project was only partly successful.
Amniotic fluid embolism. A report of three cases.
Three patients showing the typical features of amniotic fluid embolism are described. Two survived the insult, while in the third the diagnosis was confirmed by post-mortem histological examination of the lungs.
Methohexitone and etomidate for bronchoscopy.
General anaesthesia for bronchoscopy has been provided with either methohexitone or etomidate, with and without fentanyl. Recovery was faster following methohexitone and there was no statistically significant difference in the incidence of complications. Inclusion of fentanyl in the technique did not confer any benefits with either drug.
Changes in ionized calcium and other plasma constituents associated with cardiopulmonary bypass.
Plasma concentrations of calcium fractions, proteins, phosphate and magnesium were measured before, during and after cardiopulmonary bypass in 15 patients undergoing cardiac surgery. When calcium chloride was added to a pump priming solution which contained little or no blood, the concentrations of all calcium fractions were significantly greater after bypass than before, with a mean ionized calcium concentration of 1.52 mmol litre-1 plasma water, 30 min after completion of bypass. This iatrogenic hypercalcaemia was increased significantly by the administration of more than 10 mg kg-1 calcium chloride in the first 30 min after bypass. Other plasma constituents showed the dilutional effect of the pump prime during bypass and only the magnesium concentration failed to return towards normal values after operation.
Induction of labour.
The only justification for adding to the extensive literature on induction of labour is to bring together relatively inaccessible but relevant data for the general reader. Some of these data refer to current practice, and some to patients' experiences. The conflicting value systems of some doctors and some patients are also discussed. The writer, a self-confessed armchair critic, makes some suggestions about ways of reducing disagreement about elective induction of labour.
Respiratory effects of etomidate.
The respiratory effects of etomidate 0.3 mg/kg were studied in patients premedicated with either diazepam and atropine or papaveretum and hyoscine. The incidence of apnoea was 40% in those who received the non-narcotic premedication, compared with 27% in those who received the opiate. Those premedicated with diazepam and atropine showed a significant increase in respiratory frequency which was associated with a significant increase in minute volume 4 min after induction of anaesthesia. No such increase occurred in those premedicated with papaveretum and hyoscine. It would appear that the effects of etomidate on respiration are less than those of other i.v. induction agents, but involuntary muscle movement during induction remains a problem.
Expiratory bacterial filters.
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Decontamination of anaesthetic equipment and ventilators.
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Etomidate, a new water-soluble non-barbiturate intravenous induction agent.
This paper describes clinical experimence, in 100 patients, with the new non-barbiturate, water soluble induction agent, etomidate. This drug produces sleep in one arm/brain circulation-time. There was no effect on pulse-rate, a slight fall in blood-pressure, and a low frequency of apnoea. Involuntary movements were noted, and in some patients these were severe. Etomidate warrants further evaluation as an intravenous induction agent.
Insertion of central venous catheters through arm veins.
The position of the tip of a central venous catheter inserted through an arm vein is not influenced by the arm or by the vein chosen. There may be some advantage in inserting the catheter with the arm at the patient's side, although there seems to be no benefit from turning the patient's head towards the side of insertion. Because the most common malposition from an apparently uneventful insertion is due to the catheter tip entering the internal jugular vein, neck compression has been established as a useful test. If the catheter tip is well into the internal jugular vein, compression on that side of the neck should cause a rise in the recorded pressure of 10 or more cm H20. This rise should not occur on compression of the other side of the neck. We wish to emphasize that it is important to confirm radiographically the position of the catheter tip.
Anaesthetic considerations in chronic renal failure.
This paper discusses the anaesthetic problems presented by patients in chronic renal failure. The anaesthetic agents and techniques used in 181 patients who underwent 941 operations (including 218 renal transplants) are described.
Suxamethonium apnoea masked by tetrahydroaminacrine.
A case is reported of a patient who was given THA with suxamethonium and who demonstrated a prolonged apnoea. This patient was later shown to have a variant cholinesterase enzyme. The different techniques of THA and suxamethonium administration are discussed and it is suggested that an initial dose of suxamethonium should precede a THA-suxamethonium combination in order to try and avoid a prolonged apnoea.
General anesthesia in the presence of Eisenmenger's syndrome.
The theoretical implications of anesthetizing patients with Eisenmenger's syndrome are discussed and the anesthetic management of 16 such patients is described. A variety of technics were chosen which caused minimal depression of the cardiovascular system. These patients tolerate general anesthesia well and do not present the risks that have been suggested on theoretical grounds.