Biomedical subjects
P D Cartwright
Publications and source records attributed to P D Cartwright.
Back pain--must be the anaesthetic!
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Myoclonic spasms following intrathecal diamorphine.
The use of intrathecal diamorphine via an implanted portal system is described for pain control in a patient suffering from vertebral metastatic disease. The complication of myoclonic spasms affecting the lower half of the body occurred after 14 days, when increasing the bolus dose to 40 mg. The spasms lasted for 3 hr and then gradually subsided. Diamorphine was subsequently restarted at a lower dose of 15 mg twice daily. On increasing the dose to 20 mg diamorphine 10 days later, severe distressing myoclonic spasms recurred 20 min postinjection. Myoclonus could only be controlled by instituting a local anesthetic intrathecal block. The patient was finally managed with 20 mg diamorphine per day by intrathecal infusion, and the pain was reasonably well controlled for the following 10 weeks without any recurrence of myoclonic spasms.
Introducing an acute pain service.
An acute pain service in a new district general hospital is described. We have reported incidence of severe pain, common postoperative anaesthetic problems and patient satisfaction in relation to the analgesic technique. Over half the patients were treated by intermittent intramuscular injection of opioid, but increase in the use of continuous intravenous therapy and in particular patient-controlled analgesia, was welcomed by both medical and nursing staff.
Obstetric epidural test doses.
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Neurotoxicity of local anesthetics.
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Maternal heart rate changes with a plain epidural test dose.
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Two percent lignocaine spinal anaesthesia.
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When do patients given intrathecal morphine need postoperative systemic opiates.
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Airway obstruction in infectious mononucleosis.
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Pain control after surgery: a survey of current practice.
A questionnaire was sent to 302 qualified nurses in an attempt to elicit their current practice of administering postoperative analgesics, knowledge of the drugs, opinions regarding prescribing habits and comments on how pain control could be improved; 211 nurses replied (70% response). Knowledge was good but practice poor in that 56% give less than six doses postoperatively and the majority of nurses do not give analgesics until the patient is in pain; 66% thought the amount of analgesic given was a poor indication of pain experienced; 62% felt that prescribing by doctors was inconsistent and 90% thought it could be improved. Deficiencies in communication between anaesthetists, nurses and patients were highlighted. The nurses wished for more involvement in pain management and for more education of patients preoperatively. A selection of comments is included and possible simple methods for improving pain control are discussed.
Midazolam and diazepam in ketamine anaesthesia.
Midazolam 0.07 mg/kg was compared with diazepam 0.12 mg/kg intravenously as an adjuvant to ketamine anaesthesia in healthy patients undergoing minor gynaecological operations of less than 15 minutes duration. The occurrence of induction and emergence sequelae, and patient acceptance of the technique was assessed by means of a questionnaire. The incidence of unpleasant dreams was 6.7% with midazolam and 26.7% with diazepam. There was no significant difference in any other sequelae. Overall patient acceptance was high at 96.7%.