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Biomedical subjects

J M Millar

Publications and source records attributed to J M Millar.

18 recordsLinked to original sources
PubMed2002

Randomized crossover comparison of the proseal with the classic laryngeal mask airway in unparalysed anaesthetized patients.

BACKGROUND: The ProSeal is a wire-reinforced laryngeal mask airway with an additional drain tube that leads to the distal tip of the laryngeal cuff. The design should improve the seal with the larynx. METHODS: The ProSeal and classic laryngeal mask airways were compared in 180 patients in a randomized crossover study. Patients were anaesthetized without neuromuscular blocking drugs. RESULTS: The ProSeal took more time and more attempts to insert successfully than the classic laryngeal mask airway. Insertion was successful on the first attempt in 81% of cases with the ProSeal and 90% with the classic laryngeal mask airway. The ProSeal required more air to achieve an intracuff pressure of 60 cm H2O (6 ml more for size 4 and 12 ml more for size 5). Laryngeal seal pressure was better with the ProSeal than the classic laryngeal mask airway. Median seal pressure was 29 cm H2O with the ProSeal and 18 cm H2O with the classic laryngeal mask airway. Laryngeal seal pressure was greater than 20 cm H2O in 87% of patients with the ProSeal and 41% with the classic laryngeal mask airway. Laryngeal seal pressure was greater than 40 cm H2O in 21% of patients with the ProSeal and in none of the patients with the classic laryngeal mask. Once placed, the ProSeal remained a stable and effective airway. Gastric tube insertion through the drain tube was attempted in 147 cases and was successful in 135 (92%). CONCLUSION: The ProSeal is more difficult to insert than the classic laryngeal mask airway but allows positive pressure ventilation more reliably than the classic laryngeal mask airway.

Adolescent↗
PubMed2000

Perioperative local anaesthesia for reducing pain following tonsillectomy.

BACKGROUND: Pain relief after tonsillectomy is an important part of post-operative management. Sometimes local anaesthetics are administed to the tonsillar region, but their effectiveness in relieving pain has not been formally assessed. OBJECTIVES: To assess the effects of pre- and post-operative local anaesthesia for pain reduction following tonsillectomy. SEARCH STRATEGY: Cochrane Controlled Trials Register, Medline, Embase and the Oxford Pain Database. Reference lists from identified publications, including those in non-English language publications, were scanned. Date of the most recent search was September 1998. SELECTION CRITERIA: Randomised controlled trials of adults and/or children undergoing tonsillectomy alone with local anaesthetic (a) injected into the tonsillar region immediately prior to removal of the tonsils (b) injected into the tonsillar region after removal of the tonsils (c) sprayed or otherwise applied to the tonsillar region after removal of the tonsils Outcome measures included the reduction in demand for post-operative analgesia, both in terms of time elapsed to request for first analgesia and of the total amount of analgesia used. DATA COLLECTION AND ANALYSIS: All three reviewers extracted data independently and assessed trials for quality. Four authors were contacted to obtain information on either the method of randomisation or the type of intervention used. MAIN RESULTS: Thirty trials were initially identified but only six trials met the inclusion criteria. These were all published in the English language literature between 1989 and 1997. Trials were excluded because procedures in addition to tonsillectomy were undertaken, inadequate randomisation techniques were used or because group sizes were inadequate. Of the six included studies, five involved local anaesthetic injection and one application of local anaesthetic spray. These studies used validated pain scores and measurement of supplemental analgesic intake for assessment of pain. However, some studies also included inappropriate, possibly post-hoc, outcome measures such as 'global pain scores' which may have resulted in bias. No included study showed a significant difference between intervention and control, other than for outcome measures which were felt to be inappropriate, such as the one mentioned above. REVIEWER'S CONCLUSIONS: There is no evidence that the use of perioperative local anaesthetic in patients undergoing tonsillectomy improves post-operative pain control. The trials identified were of small size and several involved the perioperative co-administration of intravenous opiates which may have masked any beneficial effect of the local anaesthetic. Further randomised controlled trials are necessary.

Anesthesia, Local↗
PubMed1996

The analgesic efficacy of tenoxicam versus placebo in day case laparoscopy: a randomised parallel double-blind trial.

The analgesic efficacy and duration of action of tenoxicam, an injectable non-steroidal analgesic with a long elimination half-life, were studied in day case laparoscopy in a double-blind randomised prospective parallel placebo-controlled trial. Tenoxicam 20 mg or saline was given intravenously at induction of anaesthesia in 67 women undergoing day case investigative laparoscopy for infertility or abdominal pain. Outcome measures were time to first analgesia, pain levels at 2, 4 and 24 h plus postoperative analgesic consumption in hospital and at home. The study showed no statistically significant difference in any of these measures between the two groups. Tenoxicam 20 mg intravenously immediately pre-operatively cannot be recommended for day case surgery on the basis of this study.

Adult↗
PubMed1995

The antiemetic effectiveness of droperidol during morphine patient-controlled analgesia.

This prospective, double-blind study examined the antiemetic effectiveness of the addition of droperidol to a morphine solution for use in patient-controlled analgesia in a group of 50 patients undergoing elective lumbar laminectomy. The addition of 20 mg droperidol to 120 mg morphine in 60 ml saline given by a Baxter 'Infusor' patient-controlled analgesia device reduced the incidence of vomiting as compared to the addition of sodium chloride from 42.8% to 12.5% (p = 0.028) and of nausea from 71.4% to 29.2% (p = 0.005). The proportion of patients requiring rescue antiemetic therapy was reduced from 47.6% to 16.7% (p = 0.025) and the time interval to the first use of rescue antiemetic agent was significantly prolonged (p = 0.029). The use of droperidol was associated with an increased degree of sedation during the first 12 h after operation.

Adult↗
PubMed1995

Is day-case prostatectomy feasible?

OBJECTIVE: To assess the possibility of discharging patients, catheter-free, on the same day that they undergo contact-laser prostatectomy. PATIENTS AND METHODS: Ten patients underwent contact vaporization of the prostate using the SLT (Surgical Laser Technologies, Oaks, PA, USA) Nd:YAG laser with an MTRL10 6 mm tip. Patients were selected in the out-patient clinic for day-case surgery on the basis of their good general health and clinically small glands. All patients had pre-operative urodynamic assessment and were proven obstructed and stable. Contact vaporization was carried out under general anaesthesia. Both intra-operative blood loss and irrigant absorption were assessed. The follow-up at 3 and 6 months included American Urological Association (AUA-7) symptom scores and the measurement of urinary flow rates. RESULTS: The mean operating time was 25.2 min, with a mean application of 43.05 kJ of laser energy. The mean absorption of irrigant fluid was 30 mL and the mean intra-operative blood loss was 31 mL. Nine patients were discharged on the day of treatment. Two patients went into clot retention following discharge and had a suprapubic catheter sited, and two failed to void once discharged, necessitating catheterization for 2 weeks. At 3 and 6 months, there was a substantial decrease in the AUA symptom score and an improvement in urinary flow rate. CONCLUSION: Day-case laser prostatectomy is possible, but the patients must be selected carefully and, perhaps more importantly, a specialist day-case anaesthetist must be available.

Aged↗
PubMed1994

Reduction of pain after laparoscopic sterilisation with local bupivacaine: a randomised, parallel, double-blind trial.

OBJECTIVE: To investigate the efficacy of applying 10 ml bupivacaine 0.5% versus normal saline to the fallopian tubes under direct vision during day case laparoscopic sterilisation under general anaesthesia. DESIGN: Randomised, parallel, double-blind controlled trial. SETTING: Day Surgery Unit. SUBJECTS: Sixty women presenting for day case laparoscopic sterilisation. MAIN OUTCOME MEASURES: Time to first post-operative analgesia, and pain levels at 1 h, at discharge, and at time of first analgesia. RESULTS: In the group receiving bupivacaine, time to first analgesia was significantly longer (P = 0.03) and significantly fewer patients requested escape analgesia before the 1 h assessment (P = 0.01). This group also had significantly less pain on visual analogue scale (P = 0.04) and significantly lower categorical verbal pain scores (P = 0.01) at the 1 h assessment. By the time of discharge, there were no significant differences between the groups. Eight women in the saline group and 15 in the bupivacaine group required no escape analgesia. This difference was not significant. One woman who received saline required to be admitted overnight for severe pain. CONCLUSION: Topical application of bupivacaine to the fallopian tubes during laparoscopic sterilisation is an easy and effective contribution to the management of pain in the immediate post-operative period after day case laparoscopic sterilisation under general anaesthesia.

Adult↗
PubMed1988

Recovery and morbidity after daycase anaesthesia. A comparison of propofol with thiopentone-enflurane with and without alfentanil.

The anaesthetic conditions, recovery and side effects for 48 hours postoperatively were compared after anaesthesia for day surgery using propofol or thiopentone-enflurane with and without alfentanil. Propofol provided good conditions for surgery with faster immediate recovery (p less than 0.001); patients who received it were fit for discharge significantly sooner (p less than 0.001). Visual analogue scores of postoperative wellbeing showed an improvement in both propofol groups (p less than 0.01); after thiopentone and enflurane the scores were reduced and took 2 days to return to the pre-operative values. There was a significant (p less than 0.001) reduction in postoperative morbidity in both the groups that received propofol up to 24 hours after discharge. The addition of alfentanil improved anaesthetic conditions and reduced postoperative morbidity with both propofol and thiopentone-enflurane.

Adult↗
PubMed1987

Nausea and vomiting after prostaglandins in day case termination of pregnancy. The efficacy of low dose droperidol.

The antiemetic effects of low dose droperidol (0.25 and 0.5 mg) and a placebo were compared in patients who had received prostaglandin for day case termination of pregnancy. The incidence of nausea and vomiting was high. Low dose droperidol significantly reduced postoperative nausea and vomiting without any delay in immediate recovery or discharge home (p less than 0.05). Droperidol 0.25 mg was equally effective as an antiemetic, as 0.5 mg.

Abortion, Induced↗
PubMed1986

Spinal analgesia for transurethral prostatectomy. Comparison of plain bupivacaine and hyperbaric lignocaine.

Plain 0.5% bupivacaine and hyperbaric 5% lignocaine were compared for spinal analgesia in 100 patients undergoing transurethral prostatectomy (TURP). The time of onset, height of blockade, degree of hypotension, and blood loss were similar in both groups. The duration of blockade was considerably greater in the bupivacaine group, resulting in a significant reduction in the requirement for postoperative analgesia.

Aged↗
PubMed1984

The provision of junior anaesthetic staff for the intensive care unit of a district general hospital: a workable solution?

The problems of staffing an ICU in a District General Hospital at junior level are discussed. The needs of the Unit, the junior staff and the Anaesthetic Department and possible ways of reconciling these are outlined. A system of providing cover using pairs of junior anaesthetists is described in detail. This has been successfully in operation for 18 months and its merits are discussed.

Anesthesia Department, Hospital↗