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L J Murdoch

Publications and source records attributed to L J Murdoch.

8 recordsLinked to original sources
PubMed2000

Comparison of the incidence of complications at induction and emergence in infants receiving oral atropine vs no premedication.

We studied 120 patients less than 1 yr of age, allocated randomly to receive atropine 40 micrograms kg-1 orally 1 h before operation (group A) or no premedication (group B). All patients underwent a standardized anaesthetic, including inhalation induction with halothane followed by atracurium 0.5 mg kg-1, tracheal intubation and positive pressure ventilation. Monitoring during anaesthesia included heart rate, arterial oxygen saturation, temperature and airway conditions at induction and emergence. The incidence of a decrease in arterial oxygen saturation to 94% or less at induction and recovery was similar in both groups (30.5% at induction, 39% at extubation in group A; 31% at induction, 41% at extubation in group B). There were significantly more airway complications in group B both at induction and emergence (25% and 49%, respectively, compared with 9% and 25% in group A; P < 0.015). Mean heart rate at induction and in the peroperative period was significantly higher in the group receiving atropine (P < or = 0.001). There was an increased incidence of bradycardia (decrease in heart rate of > or = 20%) at induction in the non-premedicated group (23% in group B compared with 10% in group A), but this was not statistically significant. We conclude that the incidence of airway complications at induction and emergence was reduced by orally administered atropine premedication.

Anesthesia Recovery Period↗
PubMed1994

The cardiovascular changes associated with equipotent anaesthesia with either propofol or isoflurane. Particular emphasis on right ventricular function.

The differences in effects of anaesthetic agents on right ventricular function have not been studied. We have developed a cross-over study design to compare the effects of propofol and isoflurane on cardiac and specifically right ventricular function. Ten patients were anaesthetised with equivalent MAC of isoflurane to MIR of propofol. After measurements had been taken on the randomly assigned first agent the patients were crossed over to the other agent and measurements were repeated. Cardiac function was assessed using a pulmonary artery catheter with a fast response thermistor. There were no differences in heart rate or blood pressure between the two agents suggesting that equivalent anaesthetic doses had been given. There were significantly (P < 0.05) higher cardiac output (4.0 to 4.5 l.min-1), right ventricular ejection fraction (35.1 to 39.4%), stroke volume (35.4 to 39.6 ml) and right ventricular end-diastolic volume index (102 to 110 ml.m2-1) with propofol compared to isoflurane. We conclude that propofol results in improved right ventricular performance compared to isoflurane. We have also shown that anaesthetic agents can be compared using a cross-over study design, and have demonstrated that MAC of isoflurane and MIR of propofol can be directly compared. We suggest that propofol may be a more suitable agent than isoflurane for anaesthesia in patients who may already have impaired right ventricular function and in whom maintaining high cardiac output may be beneficial.

Aged↗
PubMed1994

Removal of a dental post from the bronchus by interventional cardiovascular techniques.

Foreign bodies lodged in the bronchial tree are normally retrieved by bronchoscopy, but if this fails then thoracotomy is necessary. The case history is presented of a patient who had inhaled a dental post which could not be retrieved either by flexible or rigid bronchoscopy. Using biplane screening and intravascular retrieval devices introduced via an endotracheal tube, the dental post was removed successfully without the need for thoracotomy.

Bronchi↗
PubMed1993

The peri-operative management of surgical insertion and removal of the intravenous oxygenator device (IVOX). A report of nine cases.

Intravenous oxygenation (IVOX) is a new technique for augmentation of gas exchange in patients who require near maximal conventional ventilatory support. Patients who require IVOX are, by definition, critically ill with a high expected mortality. At present, these high risk patients must be transferred to the operating theatre for the IVOX device to be inserted. This report describes the anaesthetic problems associated with nine patients in whom an IVOX device was inserted and removed in our institution. The mortality was six out of nine patients; all deaths occurred with the IVOX device in situ. Three patients died within 6 h of insertion. Four patients were female. The patients' ages ranged from 14 to 76 years. There were few immediate ventilation changes in the first 4 h after IVOX insertion. Inspired oxygenation concentration was reduced in only one patient. Positive end-expiratory pressure was not reduced. Peak inspiratory pressure decreased in four patients. Arterial oxygen tension increased in four patients (range 0.1-2.5 kPa) and decreased in five (range 0.1-3.4 kPa). Arterial carbon dioxide tension increased in one patient (0.3 kPa) and decreased in eight (range 0.1-2.7 kPa). Inotropic support with adrenaline, dobutamine and noradrenaline needed to be initiated or increased in eight patients. Eight patients required 2-4 units of blood to be transfused during IVOX insertion or in the following 2 h. One patient suffered an asystolic cardiac arrest during the operation, but was resuscitated successfully. Three patients survived to have the IVOX removed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Transdermal hyoscine.

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Analgesia, Patient-Controlled↗
PubMed1990

Effects of 2% lignocaine on somatosensory evoked potentials recorded in the extradural space.

We have studied the effects of extradural administration of 2% lignocaine at the L3-4 interspace on somatosensory evoked potentials recorded in the cervical extradural space before corrective surgery for idiopathic adolescent scoliosis. Eight patients in whom the equivalent volume of 0.9% sodium chloride solution was administered into the lumbar extradural space acted as a control group. Lignocaine 2% resulted in a decrease in overall amplitude, but its main effect was a significant decrease in the amplitude of the second and third peaks, suggesting an action on the dorsal columns of the spinal cord. A significant increase in latency was found in both the lignocaine and sodium chloride groups. We conclude that the use of extradural 2% lignocaine in patients undergoing scoliosis surgery may interfere with the intraoperative monitoring of somatosensory evoked potentials.

Adolescent↗