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Biomedical subjects

P J Maddern

Publications and source records attributed to P J Maddern.

6 recordsLinked to original sources
PubMed1983

Anaesthesia for the patient with impaired renal function.

Patients with renal disease are at risk of further deterioration of renal function and acute tubular necrosis when subjected to anaesthesia and surgery. Optimal fluid loading and careful selection of anaesthetic techniques and agents, appropriate monitoring and the use of mannitol and dopamine assist in the maintenance of renal blood flow and help preserve renal function in these patients. In association with renal failure, physiological changes in other systems result in reduced oxygen supply to the tissues, metabolic disturbances, impairment of the coagulation and immune defence mechanisms and an increased risk of cardiac and cerebrovascular catastrophe. Although many anaesthetic techniques including regional analgesia may be used successfully in these patients caution with most drugs, especially pethidine, phenoperidine, suxamethonium and all non-depolarising neuromuscular relaxants is recommended. Of the volatile anaesthetics currently available, halothane is the agent of choice. Oxygen therapy and close monitoring of cardiorespiratory function are necessary postoperatively.

Anesthesia↗
PubMed1982

The anaesthetic and perioperative management of the patient undergoing insertion of a peritoneo-venous shunt.

The infusion of ascitic fluid from the peritoneal cavity into the central venous circulation may relieve massive intractible ascites, and improve renal function when hepatorenal syndrome is present. preoperative preparation of these patients includes investigation of hepatic, renal, pulmonary, cardiac and neurological function, correction of electrolyte and coagulation abnormalities, restoration of normal fluid balance and the provision of supplemental vitamins and calories. Premedication is achieved with an oral benzodiazepine or an intramuscular injection of a narcotic agent. General anaesthesia is provided by thiopentone, suxamethonium, nitrous oxide, oxygen, pancuronium and a narcotic, with intermittent positive pressure ventilation. Close monitoring of cardiac, respiratory and renal function is imperative perioperatively. Postoperatively, supervision in an Intensive Care Unit is advised as complications such as cardiac failure, septicaemia and disseminated intravascular coagulation may occur.

Anesthesia, General↗
PubMed1976

Case report: pheochromocytoma. Aspects of management.

The management of a patient with Pheochromocytoma is reported. Consideration of pre-operative preparation, hazards of beta-blocking agents in the absence of alpha blockade, potential hazards of butyrophenones, control of arterial blood pressure with sodium nitroprusside and the usefulness of continous pulmonary artery wedge pressure monitoring are discussed.

Anesthesia↗