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Biomedical subjects

J V Stapleton

Publications and source records attributed to J V Stapleton.

7 recordsLinked to original sources
PubMed2000

An interdisciplinary approach to the management of complex medical and dental conditions.

Dental and medical practice often requires an interdisciplinary approach integrating the knowledge, skills and experience of all the disciplines of dentistry, medicine and its associated fields into comprehensive treatment to maximize results. Rapid and comprehensive scientific and technological advances have made it difficult for dental and medical practitioners to keep up to date in their fields; thus, to decrease practitioner frustration and increase patient benefits, an interdisciplinary approach has become essential. This report illustrates how therapy was coordinated for a young medically compromised patient with dental phobia and significant dental problems. The latest advances in dental techniques and materials, medical technology and pharmacology are highlighted. The communication and cooperation of team members with each other and with the patient and guardians is illustrated. The astute observation by a medical practitioner in an unrelated discipline led to the improvement in the quality of life for a patient.

Adolescent↗
PubMed1981

Rate of formation of norpethidine from pethidine.

The concentrations of norpethidine in blood were determined in patients recovering from abdominal surgery following both multiple i.m. injections (i.m. group) and the i.v. infusion (i.v. group) of pethidine. The rate of administration of pethidine averaged 25 mg h-1 in both groups. Concentrations of norpethidine were generally small compared with those of pethidine although the ratio of norpethidine to pethidine concentrations increased steadily over the 2 days studied. The rate of increase of blood concentration of norpethidine was 0.013 micrograms ml-1 h-1 in both groups of patients. No significant toxic effects were observed.

Female↗
PubMed1981

Pethidine clearance during continuous intravenous infusions in postoperative patients.

1 Pethidine pharmacokinetics in ten female patients during continuous i.v. infusion for 32 h post-surgery have been determined. 2 The blood clearance of pethidine (mean +/- 2.d.) measured directly was 599 +/- 135 ml/min and is in marked contrast to some reported values. 3 Other model-dependent pharmacokinetic parameters were consistent with previously reported values. 4 Pethidine and indocyanine green clearance were correlated but the correlation was mediated through body weight. 5 Pethidine clearance and steady state concentration were predictable retrospectively from linear multivariable equations involving simple physical characteristics of the patient.

Female↗
PubMed1980

Multiple intramuscular injections: a major source of variability in analgesic response to meperidine.

Meperidine (ethidine) blood concentrations following multiple intramuscular injections (100 mg) over 2 days were determined in 10 female patients undergoing elective abdominal hysterectomies or cholecystectomies. Pain was estimated by subjective bioassay and the relationship between concentration and effect determined. The blood concentration-effect curve was steep with the range from no analgesia to complete analgesia being 0.35--0.45 microgram/ml on day 1 and 0.4--0.5 microgram/ml on day 2. The mean (+/- S.D.) minimum analgesic blood concentration was 0.5 +/- 0.1 microgram/ml (n = 32). Pain control was poor during the first 4-h dosing interval. The first injection post-surgery was also found to be the least representative of all subsequent injections. Blood concentrations fluctuated in phase with dosing interval, but were highly variable. Intra- and inter-patient peak concentrations varied by 2- and 5-fold and times taken to reach the peaks by 3- and 7-fold, respectively. Hence, meperidine blood concentrations were in excess of the minimum analgesic concentration for only about 35% of each of each 4-h dosing interval. Peak concentrations were not consistently correlated with body weight or lean tissue mass. Variable pain control following intermittent intramuscular meperidine injections was shown to be due to inadequate, fluctuating and unpredictable blood concentrations.

Adult↗
PubMed1980

Relationship between blood meperidine concentrations and analgesic response: a preliminary report.

Variability in analgesic responses to intramuscularly administered meperidine has been related to variable and unpredictable blood concentrations after injection. However, the contribution of variability in the relationship between blood concentration and effect has not been examined. The present study was designed to determine the relationship between blood meperidine concentrations and analgesic effects in nine patients during the first two postoperative days. Pain was estimated by subjective bioassay. The blood concentration-effect curves were steep, with a difference of as little as 0.05 microgram/ml between the mean concentrations associated with severe pain and those associated with effective analgesia. Each curve had two inflection points: the maximum concentration still associated with severe pain (MCP) (0.41 microgram/ml, SD = 0.17, n = 76) and the minimum effective analgesic concentration (MEAC) (0.46 microgram/ml, SD = 0.18, n = 19). Interpatient variability of MEAC was appreciable (coefficient of variation = 39 percent) and intrapatient variability was also detected. Variable pain control following intermittent intramuscular injections was shown to be due not only to variation in absorption, as reported previously, but also to variation in the blood meperidine concentration-analgesic response relationships. However, correlations were found between MCP and neuroticism and extroversion scores from a personality inventory and physical variables. Thus, equations that allow prediction of an individual's MCP were derived by multivariable regression. A blood meperidine concentration of 0.7 microgram/ml would be expected to provide freedom from severe pain in approximately 95 per cent of cases. An intravenous infusion regimen for achieving and maintaining this concentration is described.

Adult↗
PubMed1979

A pharmacokinetic approach to postoperative pain: continuous infusion of pethidine.

In an attempt to improve postoperative pain management an intravenous infusion of pethidine was designed to provide stable therapeutic blood concentrations. Ten female patients undergoing elective abdominal hysterectomy were studied. After commencement of the infusion, blood pethidine concentrations increased rapidly and exceeded 0.46 microgram/ml after four hours. The mean steady-state concentration of 0.67 microgram/ml was reached by twenty-four hours. This infusion regimen resulted in the abolition of severe pain after three hours and analgesia continued for the duration of the two day study. Significant blood concentrations of the metabolite norpethidine were found although clinically no toxic effects were observed. Side effects of pethidine were infrequent. Controlled continuous intravenous infusion of pethidine produced stable blood concentrations and provided excellent pain control.

Adult↗