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Biomedical subjects

L Oakes

Publications and source records attributed to L Oakes.

6 recordsLinked to original sources
PubMed1992

Pediatric analgesia with epidural fentanyl citrate administered by nursing staff.

Even though epidural analgesia is effective and has advantages over conventional postoperative analgesia, it is also labor intensive, requiring 24-hour supervision by an anesthesiologist. In an effort to decrease the manpower requirements, some hospitals allow the nursing staff to administer epidural narcotics to adult patients. In children, however, this practice has been limited. We retrospectively reviewed our experience over 12 months with this procedure. Epidural catheters (caudal, lumbar, or thoracic) were placed in 43 pediatric patients for acute and chronic pain management. All patients received a continuous epidural infusion of bupivacaine hydrochloride with fentanyl citrate. Eleven (26%) of the 43 patients required supplemental analgesia and were given 45 doses of epidural fentanyl. Adequate analgesia was achieved in all patients. No intravascular or intrathecal injections were noted, nor did any inadvertent epidural injections of medications occur. No patient had respiratory depression (respiratory rate less than 10% for age). We believe epidural administration of fentanyl by a carefully educated nursing staff is safe and effective in children.

Adolescent↗
PubMed1992

Continuous epidural anesthesia for postoperative analgesia in the pediatric oncology patient.

When compared with conventional techniques, epidural anesthesia not only provides improved analgesia, but also has several beneficial effects on the postoperative respiratory, cardiovascular, and metabolic status of the patient. Although the efficacy of this technique in children has been demonstrated, extensive experience in the pediatric oncology patient has not been previously reported. We retrospectively reviewed our 2-year experience with epidural analgesia and discuss the techniques involved in implementing this service for the pediatric oncology patient. An epidural catheter was successfully placed in 58 of 60 patients (97%) who ranged in age from 4 months to 19 years and in weight from 4.1 to 68 kg. Postoperative analgesia was provided by a continuous infusion of a bupivacaine/fentanyl mixture, supplemented with intermittent epidural fentanyl by bolus dose as needed. No complications related to epidural catheters were noted. Our review supports the efficacy of this technique for providing postoperative analgesia after various major surgical procedures in the pediatric oncology patient.

Adolescent↗
PubMed1992

Bedside nursing research. A new category of research?

A new category of clinical nursing research, labeled "bedside nursing research," is proposed and described in this article. Justification for this research category is based on its particular characteristics, such as its narrow focus on direct care procedures that have well-defined parameters and the patient outcomes of those procedures. Findings from this type of research have high clinical relevance and can directly influence nursing practice at the study site.

Clinical Nursing Research↗
PubMed1991

Percutaneous lumbar intrathecal catheter for the administration of chemotherapy.

We present a patient with Burkitt's lymphoma in whom the initial diagnostic lumbar puncture was difficult due to a recent lumbar laminectomy and residual spinal cord tumor. According to our current protocol, he was to receive intrathecal chemotherapy for three consecutive days. To avoid the need for repeated attempts at lumbar puncture and to ensure the proper instillation of therapy, a percutaneous IT catheter was placed for 48 hours and the three doses of IT chemotherapy were administered through this catheter. Due to the importance of IT chemotherapy, options must be available to deliver these medications when technical or anatomic abnormalities exist. One such option is the short term placement of a percutaneous IT catheter.

Adolescent↗
PubMed1991

Reduction of complications associated with total parenteral nutrition by introduction of a clinical monitoring team. The Total Parenteral Nutrition Committee.

The introduction of Total Parenteral Nutrition (TPN) in the treatment of malnourished patients with unusable gastrointestinal tracts has become commonplace throughout the world. However there are significant metabolic (4.2 to 7.7%) and septic (7 to 27%) complications associated with this therapy. In 1984 a TPN committee was formed at Royal Newcastle Hospital and a TPN nurse was appointed. This series documents the use of TPN at Royal Newcastle Hospital from August 1984 to July 1989. There were 251 patients who received TPN, representing 3422 days of TPN. The primary catheter sepsis rate was 10.4% at the commencement of the series and decreased appreciably to 3.2%. The formation of the TPN committee and the appointment of a TPN nurse have represented a considerable cost in time and money but this action has been justified by the drop in the sepsis rate resulting in a decrease in morbidity and mortality associated with TPN.

Adolescent↗