Biomedical subjects
P R Bromage
Publications and source records attributed to P R Bromage.
Critique of the Dornier HM3 lithotripter as a clinical algesimeter.
The power and nociceptive intensity of shock waves generated by the Dornier HM3 extracorporeal shock wave lithotripter (ESWL) are voltage dependent and suited to algesimetry in a controllable voltage range of 8-30 kV. Fidelity of the HM3 as an algesimeter was tested by: (1) In vitro measurements of shock pressure at voltages between 14 and 30 kV were recorded by a force transducer at the point of clinical focus. (2) Unanaesthetized volunteer (n = 5) assessment and VAS pain scores of shocks in the range of 10-24 kV, yielding highly significant correlations between blinded randomized shock voltage (r = 0.88), and VAS scores (r = 0.84). (3) Voltage-tolerance curves generated from 33 ASA class 1 or 2 patients undergoing ESWL treatment under epidural analgesia with 0.125% bupivacaine, fortified with a bolus epidural dose of 100 micrograms fentanyl if pain arose during treatment. Voltage tolerance was increased by 50% after an epidural bolus of 100 micrograms fentanyl (P less than 0.001). The respiratory consequences of epidural fentanyl were assessed by changes of respiratory rate and rhythm recorded from capnographic tracings of expired carbon dioxide. This study indicates that the Dornier HM3 system provides a valuable opportunity to conduct precise, quantitative measurements of induced deep truncal pain, as well as the effectiveness and respiratory cost of analgesic interventions directly applicable to the safe management of acute pain.
Prolongation of postoperative epidural sufentanil analgesia with epinephrine.
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A nasal catheter for monitoring tidal carbon dioxide in spontaneously breathing patients.
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The control of post-thoracotomy pain.
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Influence of Dornier HM3 system on respiration during extracorporeal shock-wave lithotripsy.
Patients undergoing extracorporeal shock-wave lithotripsy (ESWL) for renal stones in the Dornier HM3 apparatus are immersed to the clavicles in water and anchored by abdominal and leg restraining straps. The respiratory effects of this system and sedation with midazolam were studied in 70 awake patients anesthetized with epidural blockade. On immersion, surface abdominal pressure and respiratory frequency (f) increased. Tidal volume (VT) and arterial saturation (SaO2) decreased. After intravenous midazolam 0.045 mg/kg body weight, VT decreased further to 35% below pre-immersion values and stone excursions measured by fluoroscopy diminished by more than 50%; reduction of VT and stone excursions were linearly correlated (R = 0.45). SaO2 declined sharply to 6.1% (range -1.5-13.8%) below pre-immersion values, whereas end-tidal CO2 (PETCO2) increased more slowly and f remained above the pre-immersion rate. In three patients, SaO2 decreased to below 85% but was rapidly restored to 98-100% by oxygen administration. The respiratory effects of sedative drugs are exaggerated by the Dornier HM3 system, and continuous monitoring of gas exchange and appropriate oxygen administration are recommended in patients receiving regional anesthesia and sedation.
A postoperative pain management service.
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Epidural air bubbles and frothy syllogisms.
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Repeated epidural anesthesia for extracorporeal shock-wave lithotripsy (ESWL) is not unreliable.
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Analgesic and respiratory effects of extradural sufentanil in volunteers and the influence of adrenaline as an adjuvant.
The effects of extradural sufentanil 50 micrograms were investigated in 10 normal volunteers. Eight of these were studied at a second session when adrenaline 1:200,000 was added to the sufentanil. Well-defined segmental analgesia developed rapidly after plain sufentanil and lasted approximately 3 h. Respiration was depressed for about the same period and was greatest in the first 2 h, as shown by a 15% increase in PECO2, while the slope and VE50 of the carbon dioxide response curve were depressed by 45% and 55%, respectively. Moderate drowsiness occurred in most subjects, while other side effects of itching, nausea and urinary retention occurred less frequently and were not severe. Addition of adrenaline 1:200,000 intensified segmental analgesia and prolonged duration to 5 h, while side effects were lessened. It is concluded that extradural sufentanil shows considerable promise for clinical use, and that the risk: benefit ratio is improved by adding adrenaline 1:200,000.
Delayed respiratory arrest after epidural hydromorphone.
A case is reported where hydromorphone 1 mg injected into the epidural space produced apnoea 4.5 hours later. No other narcotics had been given in the previous 10 hours.
Comparison of lidocaine hydrocarbonate and lidocaine hydrochloride for epidural blockade.
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Subdural migration of an epidural catheter.
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Epidural analgesia and neonatal hyperbilirubinemia.
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Extradural analgesia revisited.
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Currentness of textbook references alone not a valid measure of quality.
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Peridurography with metrizamide: animal and human studies.
Metrizamide (300 mg l/ml) was tested for spinal peridurography in conscious dogs and humans. Epidural metrizamide was non-irritating in volumes up to 12 ml. Larger volumes caused mild discomfort in two patients. Radiographic contrast was satisfactory, and there were no sequelae. Peridurography with metrizamide (300 mg l/ml) appears to be a safe, useful diagnostic procedure in ambulant patients.