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Biomedical subjects

N A Pace

Publications and source records attributed to N A Pace.

At least 19 recordsLinked to original sources
PubMed2003

The information requested by patients prior to giving consent to anaesthesia.

Patients in a teaching hospital in Scotland were given the opportunity to ask for further information relating to their peri-operative anaesthetic management. One investigator visited all of the patients pre-operatively and asked a standard list of anaesthetic-related questions. Our objectives were to determine what additional information patients would request before giving their consent to anaesthesia. The majority of patients (n=469, 67%) had no further questions at a point when so-called consent could have been obtained. Of the questions asked, 209 (66%) were related to anaesthesia and 93 (30%) to the proposed surgery. Only two patients in the group studied requested a full explanation of their peri-operative anaesthetic management. The question most commonly asked related to the duration of surgery, with less priority being given to questions relating to complications of anaesthesia.

Anesthesia↗
PubMed2001

Review of ethics in paediatric anaesthesia: consent issues.

The concepts of law and ethics as related to medical practice have always been of paramount importance to the medical profession. This series of three reviews, examines the changes in the law in the last 10 years in relation to ethics and the practice of paediatric anaesthesia. The reviews cover, in a practical question and answer format, the topics of consent, research, intensive care and organ donation issues in children.

Anesthesia↗
PubMed2001

Review of ethics in paediatric anaesthesia: research issues.

This is the second of a series of three articles reviewing the recent changes in the law in relation to ethics and the practice of paediatric anaesthesia. The review covers, in a practical question and answer format, the topics of consent, research, intensive care issues and organ donation in children.

Anesthesia↗
PubMed2001

Review of ethics in paediatric anaesthesia: intensive care issues.

This is the third of a series of three articles examining the recent changes in the law in relation to ethics and the practice of paediatric anaesthesia. The review covers, in a practical question and answer format, the topics of consent, research, intensive care issues and organ donation in children.

Anesthesiology↗
PubMed1995

Nebulized bupivacaine attenuates the heart rate response following tracheal intubation.

STUDY OBJECTIVE: To determine whether nebulized bupivacaine attenuates the acute hemodynamic response to laryngoscopy and intubation. DESIGN: Prospective, randomized, placebo-controlled study. SETTING: Operating room at a university medical center. PATIENTS: 40 health ASA physical status I and II patients scheduled for minor surgical procedures. INTERVENTIONS: Patients were randomized to receive 4 ml of a nebulized solution of either saline (n = 20) or 0.75% bupivacaine (n = 20) 15 minutes before induction of anesthesia. On completion of the aerosol treatment, fentanyl 1.5 micrograms/kg was given intravenously (i.v.), and 3 minutes later anesthesia was induced with thiopental sodium 5 mg/kg i.v. and succinylcholine 1.5 mg/kg i.v.. Laryngoscopy was begun 60 seconds after induction, and the trachea was intubated at 90 seconds. Anesthesia was maintained with 50% nitrous oxide in oxygen following intubation, and 1% isoflurane was administered at 180 seconds. MEASUREMENTS AND MAIN RESULTS: Heart rate (HR) and blood pressure were recorded automatically every 30 seconds for 5 minutes. Bupivacaine significantly attenuated HR (p < 0.05) but not the hypertensive response to laryngoscopy and intubation. CONCLUSION: Nebulized 0.75% bupivacaine was only partially effective in blunting the hemodynamic response to tracheal intubation.

Adult↗
PubMed1995

Effect of preincision versus postincision infiltration with bupivacaine on postoperative pain.

STUDY OBJECTIVE: To compare the efficacy of preincision wound infiltration with bupivacaine to wound infiltration at the end of the operation. DESIGN: A prospective, randomized, double-blind study. SETTING: University medical center. PATIENTS: 56 ASA status I and II women scheduled for abdominal hysterectomy were randomly assigned to one of three treatment groups. INTERVENTIONS: Group 1 (control) received no local anesthetic infiltration. Group 2 received subcutaneous infiltration with 40 ml of bupivacaine 0.5% (pH 6.9) 15 minutes prior to incision. Group 3 received wound infiltration with a similar solution at the end of surgery. Anesthesia was induced with thiopental 3.0 mg/kg i.v., droperidol 50 micrograms/kg i.v., and sufentanil 0.5 microgram/kg i.v. and maintained with nitrous oxide 67% in oxygen and sufentanil 0.1 microgram/kg IV boluses as required. Postoperative pain was treated with morphine via a patient-controlled analgesia delivery system for 24 hours, followed by oral hydrocodone for 3 days. MEASUREMENTS AND MAIN RESULTS: The opioid consumption was recorded for 4 days postoperatively. Pain scores were measured at 4 to 8-hour intervals using 100 mm visual analog scales. There was no difference in either the opioid analgesic requirements or the pain scores between the three study groups. CONCLUSIONS: Wound infiltration, either preincision or postincision, had no clinically significant effect on the pain scores or analgesic requirements following abdominal hysterectomy.

Adult↗
PubMed1995

Spontaneous respiration versus controlled ventilation anaesthesia with halothane for intra-ocular surgery.

One hundred and thirty-seven patients were randomly allocated to receive halothane anaesthesia for intra-ocular surgery either by IPPV (n = 71) or breathing spontaneously (n = 66). Both techniques provided satisfactory operating conditions in 87% and 80% of procedures, respectively. Intra-ocular pressure was reduced in a similar majority of patients, rose in a similar percentage (spontaneous = 11%, controlled = 21%) and remained unchanged in a few. Surgeons' reports of good operative conditions correlated very well with intra-ocular pressure changes whether they rose or fell intra-operatively. The duration of anaesthesia and the time taken to achieve full recovery following the two techniques were similar. Post-operative vomiting, headache, sore throat and confusion occurred with similar frequency, and analgesic and antiemetic requirements were not influenced by the technique. Resumption of ambulation, oral intake and micturation occurred similarly. In both groups, patients with a low normal pre-operative intra-ocular pressure tended to show a rise in intra-ocular pressure during anaesthesia, and those with a high normal pre-operative intra-ocular pressure tended to show a fall.

Anesthesia, Inhalation↗
PubMed1994

Use of the laryngeal mask airway after oesophageal intubation.

We have compared insertion of a tracheal tube and laryngeal mask airway (LMA) both with and without the presence of a tube in the oesophagus in 20 ASA I and II patients undergoing elective laparoscopy. After induction of anaesthesia and neuromuscular block, we measured the times for an experienced anaesthetist to correctly position both an LMA and a tracheal tube with and without a tube in the oesophagus. The time to intubation was significantly less with the LMA than with the tracheal tube, both with and without an oesophageal tube in place (P < 0.05). We conclude that if a tracheal tube is placed unintentionally in the oesophagus, an LMA may be used subsequently to provide rapid and effective oxygenation of the patient.

Adolescent↗
PubMed1994

Clinical audit of anaesthesia practice and adverse peri-operative events at Parkland Memorial Hospital, Dallas, Texas.

A study was undertaken to compare the quantity and nature of adverse event data collected during two equivalent time periods in 1990-1991 and 1991-1992 respectively. During the first period adverse event data were collected and reviewed sporadically, critical incidents were not specifically identified and no formal mechanism for regular presentation of these data existed. During the second period a new and detailed data collected from was introduced. The resulting data were analysed and presented to trainee and senior anaesthetists during formal clinical education sessions. Adverse incident reporting was significantly increased during the later period. Unsafe clinical practices and common errors were also more easily identified.

Adverse Drug Reaction Reporting Systems↗
PubMed1993

The effect of preoperative beta-blocker therapy on cardiovascular responses to weaning from mechanical ventilation and extubation after coronary artery bypass grafting.

The hemodynamic and electrocardiographic changes during weaning from mechanical ventilation and tracheal extubation were studied in 75 patients after elective coronary artery bypass surgery. Transfer from synchronized intermittent mandatory ventilation to spontaneous respiration through a T-piece was associated with an increase greater than 20% over baseline in systolic (SBP) and diastolic (DBP) blood pressure in 27% of patients, and in heart rate (HR) in 5% of patients. Although baseline SBP, DBP, and HR differed significantly between the patients taking chronic beta-blocker therapy and those not on beta-blockers (P values all < 0.003), there were no differences between these groups in their response to transfer to the T-piece. (P values: SBP = 0.98; DBP = 0.46; HR = 0.20). Tracheal extubation was associated with an increase greater than 20% of baseline in SBP in 18.9%, DBP in 16.2%, and HR in 5% of patients. However, there were significant differences between the chronically beta-blocked and non-beta-blocked groups, both in baseline values for SBP, DBP, and HR (P values all < 0.001), and also in the SBP response (P = 0.007) and HR response (P = 0.02) to extubation. Extubation was associated with a greater than 20% increase in SBP in 8.2% and DBP in 12.2% of chronically beta-blocked patients, compared to 40% and 23% of non-beta-blocked patients, although the DBP response was not statistically different (P = 0.14) between the groups. Similar proportions of patients in both groups increased their HR more than 20% above baseline, but the increase was much greater in the non-beta-blocked group (P = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1993

Comparison of an ephedrine infusion with crystalloid administration for prevention of hypotension during spinal anesthesia.

This study was designed to compare the efficacy of an ephedrine infusion with crystalloid administration for reducing the incidence of hypotension during spinal anesthesia. Fifty-four ASA I patients scheduled for postpartum tubal ligations under spinal anesthesia were randomly allocated to receive either 15 mL/kg of crystalloid (crystalloid group) or an ephedrine infusion (infusion group). Spinal anesthesia was performed using 70-90 mg of hyperbaric 5% lidocaine. Patients in the infusion group immediately thereafter received an ephedrine infusion at a rate of 5 mg/min for the first 2 min and then 1 mg/min for the next 18 min. The incidence of hypotension was 15/27 (55%) in the crystalloid group and 6/27 (22%) in the infusion group (P < 0.05). There was no significant difference between the groups in relation to the level of anesthesia or maximal heart rate, and hypertension did not occur in either group. We conclude that a prophylactic ephedrine infusion is effective for minimizing and managing hypotension associated with spinal anesthesia and compares favorably with crystalloid administration in this patient population in terms of efficacy and incidence of side effects.

Adult↗