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Biomedical subjects

M E McBrien

Publications and source records attributed to M E McBrien.

14 recordsLinked to original sources
PubMed2004

Anticipation and planning for anaesthesia provision within MR units in the UK.

We surveyed 33 UK MR units that have been developed by New Opportunity Funding (NOF) with reference to planning for and provision of anaesthetic services. The likely clinical and resource implications were documented. Units were developed predominantly in acute general hospitals with paediatric, critically ill and neuroscience patients represented. It may be predicted that up to 50% of newly built units will require anaesthetic provision and this should be anticipated at the planning stage. A senior anaesthetist should be involved in the planning process.

Anesthesiology↗
PubMed2001

Sevoflurane--nitrous oxide anaesthesia supplemented with remifentanil: effect on recovery and cognitive function.

The aim of this study was to compare recovery and psychomotor performance after maintenance of anaesthesia with sevoflurane or sevoflurane supplemented with remifentanil. Sixty-six per cent nitrous oxide was used in all patients. Twenty patients each were randomly allocated to maintenance of anaesthesia with sevoflurane only in concentrations necessary to maintain adequate anaesthesia or with 1.5, 1.0 or 0.5 MAC (end-tidal) of sevoflurane supplemented with remifentanil. The median dosage of remifentanil required in the last three groups was 0.21, 0.25 and 0.34 microg x kg(-1) x min(-1), respectively (p < 0.05). The median times to eye opening were 10.3, 12.7, 11.0 and 6.5 min in the four groups (p < 0.05 between the 0.5 MAC and the other groups) and for orientation 12.1, 14.9, 12.3 and 8.3 min, respectively (p < 0.05 between 0.5 and 1.5 MAC groups). There was no significant difference in the mini-mental state assessment scores or the actual discharge times from the recovery ward among the groups. Significantly greater numbers of patients could perform the critical flicker fusion test at 15 min in the group receiving the lowest concentration of sevoflurane and the highest dosage of remifentanil (p < 0.05). Patients in this group also showed the highest incidence of chest wall rigidity (p < 0.003). We conclude that, while the use of remifentanil with lower concentrations of sevoflurane facilitates early recovery, it does not influence discharge time from recovery ward and may be associated with side-effects such as chest wall rigidity.

Adolescent↗
PubMed2001

Use of methoxamine in the resuscitation of epinephrine-resistant electromechanical dissociation.

We describe three cases of electromechanical dissociation under anaesthesia that were unresponsive to doses of intravenous epinephrine given according to current Advanced Life Support guidelines, but which responded immediately to the intravenous administration of the pure alpha agonist, methoxamine. We suggest a possible mechanism to explain this finding and review the literature on vasopressor drugs used for cardiopulmonary resuscitation during electromechanical dissociation. An intravenous alpha agonist, such as methoxamine 20 mg, should be considered for any case of cardiac arrest secondary to electromechanical dissociation which is unresponsive to epinephrine given according to current guidelines.

Adrenergic alpha-Agonists↗
PubMed2000

Anaesthesia for magnetic resonance imaging: a survey of current practice in the UK and Ireland.

The lack of information about standards for anaesthetic practice in magnetic resonance imaging is of concern, since increasing requests are being made for this service, often in units not designed for the purpose. An overview of current practice was sought by conducting a postal survey of magnetic resonance units in the UK and Ireland. Replies were received from 100 units (79%), 46 of which had an anaesthetic service provided. A wide diversity of practice and opinion on the conduct of anaesthesia in this field was evident from the replies received. The survey highlighted particular areas of concern about the personal safety of anaesthetists within such units, including exposure to magnetic fields, noise and unscavenged anaesthetic gases. The evidence for such concerns is reviewed.

Anesthesia↗
PubMed1996

MDMA induced hyperthermia: report of a fatality and review of current therapy.

Ingestion of 3,4-methylene dioxymethamphetamine (MDMA), commonly known as "Ecstasy", can produce toxicity that is characterised by hyperthermia, coagulopathy, rhabdomyolysis and renal failure. We report a fatality associated with MDMA ingestion and briefly review the current literature on MDMA-induced hyperthermia.

Acute Kidney Injury↗
PubMed1996

Untoward incident reporting in obstetric anaesthesia: a 6-month prospective study in Northern Ireland.

The marked reduction in the number of cases related to the provision of anaesthesia, included in the triennial Reports on Confidential Enquiries into Maternal Deaths in the UK, may limit the educational value of such reports for anaesthetists in the future. The collection, analysis and reporting of untoward events related to obstetric anaesthesia may provide an additional method of highlighting areas of clinical practice that could be improved. We report on a prospective study to identify such untoward incidents related to obstetric anaesthesia in the well circumscribed population of anaesthetists involved in this specialty in Northern Ireland. In total, 22 incidents were reported during the 6-month period of the study. A brief summary of each event is included along with a more detailed description from a sample of the reports. The advantages and disadvantages of untoward incident reporting are discussed, with recommendations made for a future survey.

Journal Article↗
PubMed1995

A comparison of three variable performance devices for postoperative oxygen therapy.

Eleven patients in the intensive care unit following major abdominal surgery with a nasogastric tube in situ and receiving oxygen via facemask were allocated to receive in a random sequence oxygen at 4 l.min-1 via a Hudson mask, nasal cannulae or a nasal catheter with foam collar at the distal end. A significantly greater PaO2 was achieved using both the nasal catheter with foam collar (p < 0.01) and Hudson mask (p < 0.05) compared to the nasal cannulae. There were no significant differences in the PaCO2 or SpO2 values obtained between the devices. In the majority of postoperative patients in whom a variable performance device is indicated, nasal devices appear preferable in terms of patient comfort and compliance. The nasal catheter with foam collar produced a significantly greater PaO2 than nasal cannulae in patients with a nasogastric tube in situ.

Adult↗
PubMed1992

Advanced airway control in trauma resuscitation.

Definitive airway control which may require endotracheal intubation with or without an induction agent and muscle relaxant is an essential component of trauma resuscitation. We reviewed the delivery of advanced airway care in the resuscitation room of a regional trauma centre. This prospective survey suggests that in the absence of an experienced anaesthetist, A&E staff with a background of suitable training and experience may undertake the anaesthetic responsibility associated with securing a definitive airway when the situation demands.

Adolescent↗