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Biomedical subjects

N W Goodman

Publications and source records attributed to N W Goodman.

At least 19 recordsLinked to original sources
PubMed1992

Sighs and their effect on the breathing of patients anaesthetized with infusions of propofol.

Twenty-one spontaneous sighs were analysed from records of the breathing of 10 patients anaesthetized for 22-42 (mean 28.7) min with propofol infusions. Sighs occurred in eight patients, the rate varying between once in 29 min and four times in 26 min. There was no pattern in breaths preceding sighs, but the succeeding breaths were altered. On the first succeeding breath, tidal volume was reduced by a mean of 32% (95% confidence limits 19-44%; P less than 0.01) and inspiratory time by a mean of 15% (95% confidence limits 8-22%; P less than 0.01) of the means of the preceding breaths. These effects lasted on average at least 10 breaths. Expiratory time was usually slightly prolonged after a sigh, but this effect was less clear, less consistent and less prolonged. Sighs in patients anaesthetized with propofol reduce the ventilatory drive (in terms of mean inspiratory flow), and alter the timing, of succeeding breaths.

Adult↗
PubMed1992

Analgesia for labour and delivery using incremental diamorphine and bupivacaine via a 32-gauge intrathecal catheter.

Twenty mothers who had requested regional analgesia during labour had a 32-gauge catheter inserted into the lumbar subarachnoid space. The mean time to place the catheters was 116 s (range 55-270 s) and there were no technical difficulties. Incremental diamorphine was given, up to a maximum initial dose of 0.5 mg. Analgesia was excellent in 11 mothers, good in seven and unsatisfactory in two. The duration of initial analgesia from diamorphine was 101 min (range 30-170 min). Eight mothers were able to move about during the first stage, with effective analgesia. Side effects were common: 15 mothers had pruritus, 15 had nausea or vomiting, and eight had mild sedation. No mother had a ventilatory frequency of less than 12 b.p.m. in the 12 h after the last dose of intrathecal diamorphine. Intrathecal 0.5% bupivacaine was given to 16 mothers in the first stage because the analgesia after a top-up with diamorphine became insufficient later in the labour. Fifteen mothers were pain free after bupivacaine; there was one failure. The initial effective dose of bupivacaine was between 0.25 ml and 2 ml. The maximum height of the block after bupivacaine was T9, and there was no hypotension. Nine mothers were given hyperbaric 0.5% bupivacaine 1-2 ml during the second stage; all were pain free for the procedure. The maximum force needed to withdraw the catheters was 700 g; and all catheters were removed intact. There were no post-spinal headaches.

Adult↗
PubMed1992

Statistical awareness of research workers in British anaesthesia.

A survey was made of simple statistical errors in the precirculated booklets of abstracts to the Anaesthetic Research Society. In the five booklets June 1988-November 1989, only four of 19 figures included clearly labelled error bars when necessary; in four figures there was no indication of variability. In a more detailed survey of the 115 abstracts presented in 1990, errors were placed in categories: the presentation of method or choice of statistical test; variability; probability. There was a total of 115 errors in 61 abstracts, which was 65% of the 94 abstracts presenting numerical information. The most common errors were: failure to identify tests of inferential statistics (n = 29 abstracts); failure to present data to allow interpretation of P values (n = 21); misuse of SEM (n = 13). Confidence limits were given in seven abstracts. Type II (beta) error was not searched for formally, but no abstract that reported a negative result included the power of the study. With this level of elementary errors, there is considerable room for improvement in the use of straightforward guidelines to the presentation of statistical information. The problem is not confined to British anaesthesia: in more than 30% (25 of 71) of the figures contained in abstracts of the International Anesthesia Research Society in 1990, plots of variables against time showed only mean values.

Anesthesia↗
PubMed1991

Meanings.

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Language↗
PubMed1991

Comparison of incremental spinal anesthesia using a 32-gauge catheter with extradural anaesthesia for elective caesarean section.

Forty-three mothers who had requested regional anaesthesia for elective Caesarean section were allocated randomly to receive either extradural anaesthesia with pH-adjusted 2% lignocaine with 1/200,000 adrenaline, or incremental spinal anaesthesia using a 32-gauge catheter with 0.5% plain bupivacaine. Increments of lignocaine or bupivacaine were given with the aim of achieving a block from T4 to S5. The spinal catheter was quicker to place (median 3 min, range 1-45 min, compared with median 10 min, range 1.5-50 min) and spinal anaesthesia was quicker to establish (median 20 min, range 10-46 min compared with median 48 min, range 15-59 min) compared with the extradural technique. The maximum height of the spinal block was significantly higher (median T3-4, range T5-T3) than the extradural group (median T5, range T6-T3). The total dose of intrathecal 0.5% bupivacaine was unpredictable, with a mean dose of 2.7 ml and a range between 1.5 ml and 7.4 ml. Haemodynamic stability and the quality of the block were similar between the groups. There were two mild spinal-headaches in the spinal group. All the spinal catheters were removed intact.

Anesthesia, Epidural↗
PubMed1991

Incremental spinal anaesthesia using a 32-gauge catheter.

Incremental spinal anaesthesia using a 32-gauge intrathecal catheter was studied in 13 males scheduled for transurethral resection of the prostate or repair of inguinal hernia. The spinal technique failed in four patients. Dose-response curves were obtained in the remaining nine patients using increments of 0.5% plain bupivacaine. The spinal block was extended safely and reliably without cardiovascular instability. No patient had any postoperative headache and all catheters were removed intact.

Aged↗
PubMed1991

Resource allocation: idealism, realism, pragmatism, openness.

Lewis and Charny have come under siege for suggesting remote questioning to decide appropriate medical care. While the criticisms are theoretically valid, the idea is so important practically that Lewis and Charny should be supported and their approach investigated as a way of making medical treatment at least more open and possibly more fair.

Community Participation↗
PubMed1990

Gastro-oesophageal reflux during elective laparoscopy.

An oesophageal pH electrode was used to record gastro-oesophageal reflux in 73 women who had elective laparoscopy for various gynaecological procedures. No refluxes were recorded during the 63 procedures from which results could be analysed; the upper 95% confidence limit from this observation is 3 in 63 (4.8%). Two of the excluded women refluxed during episodes of hiccough that occurred shortly after induction of anaesthesia. Tracheal intubation may be required during laparoscopy, although the need to protect against the possibility of aspiration of gastric contents may not be a valid reason unless, with the same logic, it is suggested that all patients who hiccough should be intubated.

Adolescent↗