Early thoughts on 'Why Mothers Die 2000-2002'.
Explore the source record for details and available documents.
Anesthesia, Obstetrical↗
Biomedical subjects
P A Clyburn
Publications and source records attributed to P A Clyburn.
The Riyadh Intensive Care Program applied to a mortality analysis of a teaching hospital intensive care unit.
A computerised system of prediction of death using the Riyadh Intensive Care Program was applied retrospectively over a 17-month period to data collected prospectively on 1155 patients admitted to our intensive care unit. Variables which enable organ failure scores to be generated were recorded daily to make these predictions. Consultant medical opinion predicted that outcome was hopeless in 55% (115/209) of the patients who died. The predictive power of the computer demonstrated a sensitivity of 14.8% and a specificity of 99.8%. It is possible that the occurrence of three false predictions of death in the latter part of the series may have been related to a change in our antibiotic policy. We would be unhappy to recommend the general use of a computerised program for prediction of death without careful explanation of its significance and dangers.
Aged↗
Propofol in short gynaecological procedures. Comparison of recovery over 2 days after anaesthesia with propofol or thiopentone as sole anaesthetic agent.
Recovery was assessed over 48 hours after anaesthesia with propofol or thiopentone as sole anaesthetic agent in 36 unpremedicated gynaecological patients. Immediate recovery, as measured by the Steward scale, was shown to be quicker for the patients given propofol. At one hour postoperatively the thiopentone group showed impaired visual-motor coordination on the aiming test (p less than 0.01) and dexterity task (p less than 0.05), and a slowing of reaction time (p less than 0.01). Patients given propofol showed only an increase in reaction time (p less than 0.05). By 2 hours the thiopentone group showed impairment only in the aiming task (p less than 0.05). No further significant impairment was detected at 4, 24 or 48 hours. However, patients reported symptoms throughout the 48 hours indicative of residual drug effects. There was a substantial practice effect with some tests which may have obscured impairment. It can be argued therefore that the better recovery profile after propofol is still evident at 24 hours.
Adolescent↗
Comparison of the respiratory effects of i.v. infusions of morphine and regional analgesia by extradural block.
The incidence of postoperative respiratory apnoea was compared between five patients receiving a continuous i.v. infusion of morphine (mean 73.6 mg) and five patients receiving a continuous extradural infusion of 0.25% bupivacaine (mean 192 mg) in the 24-h period following upper abdominal surgery. Monitoring consisted of airflow detection by a carbon dioxide analyser, chest wall movement detected by pneumatic capsules, and continuous electrocardiograph recorded with a Holter ambulatory monitor. Both obstructive (P less than 0.05) and central apnoea (P less than 0.05) occurred more frequently in patients who had a morphine infusion. There was also a higher incidence of tachyarrhythmias (P less than 0.05) and ventricular ectopic beats (P less than 0.05) in the morphine infusion group.
Abdomen↗
The oculo-emetic reflex. A rationalisation of postophthalmic anaesthesia vomiting.
Data related to the incidence of postoperative vomiting were collected during prospective studies on 607 ophthalmic surgical patients of all ages who underwent halothane anaesthesia with spontaneous ventilation. Analysis of data in respect of age, sex and surgical site variables, and time of onset of vomiting, identified a female sex-related vomiting incidence of about 13% and a squint-related vomiting incidence of about 41%; no relationship between age and vomiting was identified. The analyses showed that squint surgery predisposed particularly to emesis, and was associated with a high incidence of both early and delayed vomiting. It is suggested that the apparent absence of an age-vomiting relationship in ocular, and especially squint, surgery, and the high incidence of vomiting, particularly the early vomiting associated only with squint surgery, provide clinical evidence for the existence of an oculo-emetic reflex. Our observations show that intra- and postoperative surgical stimulation of this oculo-emetic reflex is reflected in the incidences of vomiting after ocular surgery.
Adolescent↗
Propofol-induced anaesthesia. Double-blind comparison of recovery after anaesthesia induced by propofol or thiopentone.
Postoperative psychomotor and cognitive recovery were assessed after anaesthesia induced by either propofol or thiopentone, and maintained with nitrous oxide and halothane in 40 unpremedicated dental patients. Performance was shown to be impaired one hour postoperatively for the whole sample in hand-eye coordination (p less than 0.001), reaction time (p less than 0.001) and digit span (p less than 0.05). There was evidence of impairment at 3 hours postoperatively in reaction time (p less than 0.05) and ataxia (p less than 0.01). Performance also deteriorated in the dexterity and aiming tasks. Patients reported significantly less clumsiness by 24 hours in blurred vision and shivering (p less than 0.05) and by 48 hours less coughing (p less than 0.05). However, there was no significant difference between groups. No evidence showed that recovery in the propofol group was faster, so it was concluded that induction with propofol offered no advantage when anaesthesia is maintained with nitrous oxide and halothane for the periods of time reported in this study.
Adolescent↗
Flecainide and cardiac dysrhythmias during dental extraction under anaesthesia.
In a randomized double-blind study, either oral flecainide acetate 400 mg (a Class IC anti-dysrhythmic drug) or placebo was given in two divided doses 12 and 2 h pre-operatively to 38 patients undergoing outpatient molar extractions under halothane anaesthesia. The ECG was continuously monitored from the patients' arrival at the out-patient theatre until discharge, using a two-channel ambulatory magnetic tape recorder. There was a much lower incidence of ventricular dysrhythmias in patients who received flecainide (22%) than those who received placebo (75%) (P less than 0.05). In addition, dysrhythmias were both more severe and more prolonged in the untreated group, prompting treatment with intravenous practolol in seven patients (35%). Flecainide was well tolerated and no adverse effects were reported.
Adolescent↗
Oral controlled-release morphine and gut function: a study in volunteers.
The effects of a single 30-mg tablet of oral controlled-release (OCR) morphine (MST) on gastric emptying and small-intestine transit time (SITT) were compared with placebo in a double-blind, cross-over trial, on ten healthy volunteers. Gastric emptying was measured by paracetamol absorption and SITT by the rise in breath hydrogen after a carbohydrate test meal. There was no alteration in the absorption of paracetamol given 90 min after OCR administration but this was well before peak plasma morphine levels occurred. However, 30% of subjects had nausea after OCR morphine. Mean SITT in controls was 300 min (range 120-460 min) which was significantly prolonged in eight of the 10 subjects (P less than 0.05) and beyond the study period of 480 min in six subjects. Further study is required to determine how this compares with intramuscular morphine. Peak blood levels of morphine occurred at 3 h with a mean plasma concentration of 12.3 micrograms l-1 (SEM 2.0 micrograms l-1).
Administration, Oral↗
Patient-controlled analgesia with a mixture of pethidine and doxapram hydrochloride. A comparison of the incidence of respiratory dysrhythmias with pethidine alone.
Twenty-four patients who underwent elective cholecystectomy received double-blind increments of either pethidine 30 mg or a mixture of pethidine 30 mg and doxapram 45 mg delivered on a patient-controlled basis. A loading dose of doxapram 100 mg or saline was administered. There was no difference in respiratory depression as indicated by respiratory frequency and end tidal carbon dioxide concentration. The incidence of respiratory apnoea was similar in the two groups but apnoea was of shorter duration in patients who received doxapram, although the difference was not significant. Patients who received doxapram assessed overall pain as worse on a linear analogue scale (p less than 0.05) but demanded similar amounts of pethidine. There was no difference in pain on movement.
Adult↗
Comparison of the effects of dopamine, dobutamine, and dopexamine upon renal blood flow: a study in normal healthy volunteers.
1. We compared the effects of dopexamine, dopamine and dobutamine on the heart rate, blood pressure and renal blood flow of six healthy volunteers in an open triple crossover trial. 2. The results suggest that at the dose ranges investigated dopamine was the most effective agent for increasing renal blood flow.
Adult↗
Control of ventilation by continuous infusion of pancuronium bromide.
Certain groups of patients who require prolonged intermittent positive pressure ventilation in the Intensive Therapy Unit are difficult to manage with conventional sedative and narcotic drugs, and require muscle paralysis. In such cases, the authors have preferred a continuous infusion of a long-acting muscle relaxant using a syringe pump rather than intermittent injections. The technique and apparatus employed in the Intensive Therapy Unit at Northampton General Hospital are described.
Humans↗