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Biomedical subjects

M J Boscoe

Publications and source records attributed to M J Boscoe.

At least 19 recordsLinked to original sources
PubMed1997

Antiseptic-impregnated central venous catheters reduce the incidence of bacterial colonization and associated infection in immunocompromised transplant patients.

The incidence of bacterial colonization of central venous catheters using a standard polyurethane catheter was compared with that using an antiseptic (silver sulphadiazine and chlorhexidine) impregnated catheter in a group of patients with thoracic organ transplantation. Colonization was reduced from 25 of 35 standard catheters to 10 of 44 study catheters (P < 0.002), a 68% reduction. Similarly, the incidence of concomitant infection, by the same organism at another site was reduced from 10 of 35 standard catheters to 4 of 44 study catheters (P < 0.03), a 63% reduction.

Adult↗
PubMed1987

Clinical applications of crossed immunoelectrophoresis to the study of complement activation.

The purpose of our study was to set up a reliable method for the measurement of complement activation by adapting the method of crossed immunoelectrophoresis. We utilised anti C3 antiserum and barbitone buffer, containing sufficient EDTA to prevent in vitro activation of complement. We studied 44 patients undergoing open heart surgery, with cardiopulmonary bypass (CPB) by the analysis of plasma samples taken during the operation, and also samples of plasma and dialysate effluent from patients with end stage renal failure undergoing continuous ambulatory peritoneal dialysis (CAPD). Measurements were also carried out on stored blood, aged serum and serum treated with varying doses of lipopolysaccharide (LPS). Complement activation occurs in 95% of patients during CPB with levels ranging from less than 4.5% to 11.3% of total C3, but there was no detectable activation in any pre-bypass sample. Negligible complement activation occurs in the plasma of CAPD patients, but the dialysate effluent gave results from undetectable levels to 31.7%, in the absence of clinical peritonitis. Variable in vitro complement activation occurs in aged serum, but it was not detectable in stored blood. Serum treated with LPS showed levels of activation directly proportional to the dose of LPS and measurable at a level of 0.1 microgram/ml of serum. The method had a coefficient of variation of 4.5%, and provides a reliable way of measuring complement activation in clinical situations such as cardiopulmonary bypass and peritoneal dialysis.

Cardiopulmonary Bypass↗
PubMed1984

Lorazepam in open-heart surgery--plasma concentrations before, during and after bypass following different dose regimens.

Thirty-six patients (29 males and 7 females) undergoing open-heart surgery received one of three different dose regimens of lorazepam. All received a weight-related oral dose (2 mg, 3 mg or 4 mg) pre-operatively for night sedation. Twenty-four patients had an additional weight-related dose (2 mg, 3 mg or 4 mg intravenously) either as part of the induction (12 patients) or just prior to connection of the heat-lung machine (12 patients). Plasma concentrations of lorazepam were measured 20 minutes after induction, immediately before bypass, 30 and 60 on bypass and 30 minutes after bypass. Only when additional intravenous lorazepam was given prior to connection to the heart-lung machine were plasma lorazepam concentrations obtained compatible with complete amnesia.

Adult↗
PubMed1984

A comparison of diazepam and midazolam as sedatives for minor oral surgery.

Diazepam in propylene glycol (Valium, Roche) and midazolam (Hypnovel, Roche) were compared as sedatives in 40 patients undergoing minor oral surgery. Twenty patients received each drug. The cardiovascular effects, the acceptability of the drugs to patients and dentists and the incidence of anterograde amnesia and adverse venous sequelae were investigated. Serum benzodiazepine levels were measured and recovery studied by six psychomotor tests repeated over five hours. Both drugs provided safe and acceptable sedation. More amnesia was reported in the midazolam group and more adverse venous sequelae by the diazepam patients. The recovery tests showed that the time taken to return to pre-sedation scores varied with the tests used and there was no significant evidence of the midazolam group recovering more quickly. In particular, significant impairment of delayed memory recall persisted in both groups throughout the investigation period.

Adolescent↗
PubMed1983

Complement activation during cardiopulmonary bypass: quantitative study of effects of methylprednisolone and pulsatile flow.

Forty four patients undergoing open heart surgery were divided into three groups. Group 1 (17 patients) underwent routine anaesthesia and surgery; group 2 (17 patients) received two doses of methylprednisolone (30 mg/kg), one during induction of anaesthesia and the other immediately before induction of cardiopulmonary bypass; and group 3 (10 patients) received pulsatile flow while undergoing pulsatile perfusion by the heart-lung machine. A modification of the previously described technique was used to detect and measure complement activation in plasma before and during the bypass period using crossed immunoelectrophoresis. About 45% of all patients showed measurable complement activation (greater than 4.5%) during cardiopulmonary bypass and the mean activation in this group was 6.4%. There was no significant difference between the three groups in complement activation. In group 2, however, women showed significantly more complement activation than men (p less than 0.05). It is suggested that neither corticosteroids nor pulsatile flow affect complement activation, but caution should be exercised in women receiving methylprednisolone.

Animals↗
PubMed1983

Catecholamine and cortisol responses to sufentanil-O2 and alfentanil-O2 anaesthesia during coronary artery surgery.

The effects of alfentanil-O2 and sufentanil-O2 anaesthesia on plasma catecholamines and cortisol were investigated in 32 patients undergoing coronary artery bypass grafting operations. After lorazepam-atropine premedication and pancuronium pretreatment, alfentanil was given to 16 patients at a rate of 3 mg.min-1 and sufentanil was given to 16 patients at 300 micrograms.min-1 until the patients were unconscious; at this time they were given succinylcholine and were intubated. After intubation an amount of alfentanil or sufentanil equal to the dose producing unconsciousness was infused over the next 30 min, at which time the operation began. Additional alfentanil or sufentanil were given whenever systolic arterial blood pressure increased more than 15 per cent of preanaesthetic values. Arterial blood samples were obtained for epinephrine, norepinephrine and cortisol assay and cardiovascular dynamics were recorded prior to anaesthetic induction, 5 min after tracheal intubation, immediately prior to and five min after incision, ten min after maximal sternal spread, just prior to beginning and after 30 and 60 min of bypass and at the end of operation. Cardiovascular dynamics were little changed throughout anaesthesia and operation. Plasma epinephrine and norepinephrine were not significantly changed until bypass. During bypass both hormones became increased and remained increased at the end of operation. Plasma cortisol decreased after incision and remained decreased until the end of operation. These data indicate that alfentanil-O2 and sufentanil-O2 anaesthesia produce similar changes in plasma catecholamines and cortisol as does fentanyl-O2 anaesthesia and hormonal effects are, therefore, not an explanation for any advantages the newer narcotics may have over fentanyl.

Adult↗
PubMed1983

Quinine overdose. Prevention of visual damage by stellate ganglion block.

A case of quinine poisoning is described. Stellate ganglion block was performed immediately on the basis of the clinical history of visual disturbance without waiting for physical signs to develop. There was no residual field defect despite the presence of toxic levels of the drug. It is suggested that stellate ganglion block may prevent development of visual field defects.

Adult↗
PubMed1982

The influence of chronic preoperative propranolol therapy on cardiovascular dynamics and narcotic requirements during operation in patients with coronary artery disease.

We measured the dose of sufentanil required for unconsciousness as well as the entire operation in 44 patients (22 taking propranolol and 22 not taking propranolol) undergoing coronary artery bypass grafting (CABG) operations. The incidence of hypertension during operation, requirements for supplements to treat hypertension and recovery times were also determined. The data indicate that patients undergoing CABG operations taking propranolol require significantly less sufentanil for unconsciousness and the entire operation than patients not taking this drug. In spite of requiring less sufentanil, patients taking propranolol had less hypertension during operation and thus required less supplements. However recovery times in both groups were the same. The results of this study may partially explain the varying incidence of hypertension reported during high dose fentanyl and other narcotic-oxygen anaesthetic techniques.

Anesthesia, General↗
PubMed1982

Antidiuretic and growth hormone responses during coronary artery surgery with sufentanil-oxygen and alfentanil-oxygen anesthesia in man.

Antidiuretic hormone (ADH), growth hormone (GH), and cardiovascular responses to large (anesthetic) doses of alfentanil (1.2 +/- 0.02 mg/kg) and oxygen and sufentanil (13.1 +/- 0.4 microgram/kg) and oxygen were measured before and during surgery (including cardiopulmonary bypass) and at the end of surgery in 29 patients undergoing coronary artery bypass surgery. The data demonstrate that alfentanil-O2 and sufentanil-O2 result in little change in cardiovascular dynamics throughout anesthesia and surgery, and also prevent changes in plasma levels of ADH and GH at all times during the study. Our findings contrast with previous studies with other anesthetics, including fentanyl, in which plasma levels of ADH and GH become markedly elevated during bypass. The results suggest that alfentanil and sufentanil may block hormonal stress responses to surgical stimulus better than fentanyl does. The clinical significance of the difference in ADH and GH responses during fentanyl and during alfentanil or sulfentanil anesthesia remains to be determined. However, this difference may provide part of the explanation why alfentanil and sufentanil-O2 anesthesia require less frequent employment of other anesthetic adjuvants and are easier to use than fentanyl during coronary artery surgery.

Alfentanil↗