PubMed Health⌕ Search

Biomedical subjects

N W Lees

Publications and source records attributed to N W Lees.

13 recordsLinked to original sources
PubMed1989

The effects of speed of injection on induction with propofol. A comparison with etomidate.

One hundred and eighty female patients received either propofol 2.5 mg/kg or etomidate 0.3 mg/kg injected over 20, 40 or 80 seconds for induction of anaesthesia after premedication with temazepam 20 mg. The mean induction times for both etomidate and propofol were significantly reduced with increasing speed of injection. The mean induction times for etomidate were significantly less than propofol at the slower rates of injection. At each speed of injection, the decrease in systolic, mean and diastolic arterial blood pressures with etomidate were less than with propofol. The decrease in systolic blood pressure was not significantly affected by injection speed for either drug. Apnoea occurred significantly more frequently with propofol than with etomidate at each speed of injection and the incidence of apnoea greater than 60 seconds with propofol was significantly higher when injected over 20 seconds than 80 seconds. The incidence of pain on injection was unaffected by injection speed for either drug. The incidence of myoclonus and (or) hypertonus was significantly higher following etomidate.

Adult↗
PubMed1985

Assessment and modification of pain on induction with propofol (Diprivan).

Assessment of pain on injection of the emulsified formulation of di-isopropylphenol (propofol, 'Diprivan') was undertaken in 120 unpremedicated patients and comparison made with thiopentone. A high incidence of pain (37.5%) was found using dorsal hand veins, but use of forearm veins showed only a 2.5% incidence of pain. The use of intravenous lignocaine immediately before propofol injection only partially reduced the incidence of pain using dorsal hand veins (17.5%). A degree of cardiorespiratory depression accompanied induction but the incidence of other side effects was low.

Adult↗
PubMed1985

Propofol ('Diprivan') for induction and maintenance of anaesthesia.

The use of propofol for the induction and maintenance of anaesthesia was investigated. Induction with propofol was straightforward, with only a small drop in blood pressure. Pain on injection was the only noteworthy complication, particularly when propofol was injected via a small vein in the dorsum of the hand. A rapid infusion of 9.0 mg/kg/h for 30 min and then 4.5 mg/kg/h supplemented with fentanyl maintained anaesthesia without problem. The duration of action of atracurium was unaffected by the infusion of propofol, but the duration of action of vecuronium appeared to be prolonged. Three investigations of propofol, dissolved in soya bean oil, were carried out.

Anesthesia, Intravenous↗
PubMed1984

Two-stage infusion of etomidate for the induction and maintenance of anaesthesia.

A two-stage infusion technique of etomidate with a separate infusion of fentanyl was compared with thiopentone and halothane or morphine, plus nitrous oxide in oxygen, for the induction and maintenance of anaesthesia in 200 patients. Cardiovascular and respiratory indices and recovery times were found to be similar in the two groups.

Aged↗
PubMed1984

Alfentanil in minor gynaecological surgery: use with etomidate and a comparison with halothane.

Etomidate was used to induce anaesthesia in 50 healthy subjects undergoing minor gynaecological surgery who were randomly divided into two groups, one receiving alfentanil 8 micrograms/kg intravenously immediately prior to induction of anaesthesia with etomidate, and the other halothane as required to maintain adequate anaesthesia. There was a highly significant reduction in the incidence of myoclonia and involuntary movement and significant reduction of pain on injection in the alfentanil group. Tests of recovery performed in the 60 minutes following anaesthesia suggested that supplementation with alfentanil led to more rapid recovery than halothane.

Adjuvants, Anesthesia↗
PubMed1982

Drug recognition by nurses and anaesthetists.

A survey of nurses and anaesthetists in a 500-bed teaching hospital set out to discover how they located a drug container in order to read its label and verify its contents. Members of each group assessed the value of seven factors thought to help in this location and answered questions on personal errors in drug administration. The nurses found the expected position of the drug container in the trolley or cupboard to be the most important factor, followed by the size of the container. The anaesthetists placed the colour of the container as most important, followed by the manufacturer's distinctive container as their second best guide to drug location. This preference for colour and a distinctive container can be used to reduce the chance of confusing drugs locally. A scheme for colour-coding ampoules in broad groups to reduce gross mistakes in the future is presented.

Anesthesiology↗
PubMed1981

Etomidate and fentanyl for maintenance of anaesthesia.

An infusion of etomidate and fentanyl was compared with halothane or morphine plus nitrous oxide in oxygen for the maintenance of anaesthesia in 200 patients. Cardiovascular and respiratory changes were found to be similar in the two groups. There was a prolongation of recovery time in the etomidate-fentanyl group: this was possibly a result of lack of flexibility in the infusion technique.

Anesthesia, Inhalation↗
PubMed1976

The diagnosis and treatment of endotoxic shock.

The management of a severe case of endotoxic shock is a prolonged and strenuous exercise. The initial aim is to achieve, as soon as possible, cardiorespiratory stability and control of the septic focus, thereafter, the provision of fluid and nutrition must be adequate. Constant observation is required so that swift action can be taken if complications such as haemorrhage or renal failure develop, or if there is failure to control the septic focus. The general welfare of the patient, with particular regard to general nursing care, reduction of the risk of secondary infection and reassurance also plays an important part. Efficient treatment requires an organised plan which covers all the relevant aspects and assigns priorities to the critical areas.

Acute Kidney Injury↗
PubMed1975

Effects of ambulance transport in critically ill patients.

Two groups of critically ill patients were transferred by ambulance from other hospitals to a central intensive therapy unit. The effect of transport was reviewed retrospectively in 46 patients and prospectively in 20 patients. Of the 46 patients reviewed retrospectively six became hypotensive, six became hypertensive, and seven developed delayed hypotension. One patient developed fits and six out of 13 patients had a rise in arterial PCO-2 of 1-6-4-1 kPa (12-31 mm Hg). Of the 20 patients reviewed prospectively, one patient became hypertensive due to overtransfusion, one had a fit, but none became hypotensive. Three out of four cases of delayed hypotension were related to starting intermittent positive pressure ventilation. Arterial PCO-2 fell in one patient and arterial PCO-2 rose in two, each change being related to changed oxygen therapy or narcotics. There were no changes in other cardiovascular or respiratory indices, body temperature, or urine production. Earlier transfer, resuscitation before transfer, continuing medical care during the journey, and hence a slower smoother journey seemed to be important factors in the management of these patients. Our findings, may have important implications in the future regional organization of the care of critically ill patients.

Adult↗
PubMedDate not supplied

Etomidate in a new solvent. A clinical evaluation.

The introduction of polyethylene glycol as a solvent for etomidate appears to markedly reduce the incidence of pain on injection while maintaining the previously demonstrated advantageous features of cardiovascular stability and rapid recovery.

Anesthesia, Intravenous↗
PubMedDate not supplied

Etomidate in urological outpatient anaesthesia. A clinical evaluation.

Induction of anaesthesia with the new short acting agent etomidate has been studied in 200 patients undergoing urological outpatient procedures. These patients exhibited a similar pattern of recovery to those receiving 7 mg/kg propanidid but had greater cardiac and respiratory stability. However, there was a 25% incidence of pain which was reduced to 13-9% by increasing the rate of injection from 30 to 15 seconds. The incidence of involuntary movements was 29-7% which was reduced to 15% by the faster rate of injection. The omission of atropine premedication did not affect cardiac stability. Etomidate appears to have many desirable features as an induction agent except for a high incidence of pain on injection which is reduced by rapid injection.

Anesthesia, Intravenous↗