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Biomedical subjects

R J Birks

Publications and source records attributed to R J Birks.

8 recordsLinked to original sources
PubMed1989

A comparison between open-end (single hole) and closed-end (three lateral holes) epidural catheters. Complications and quality of sensory blockade.

A randomised, single-blind study was conducted on 802 parturient women who required epidural analgesia, to compare open-end (single hole) with closed-end (three lateral holes) epidural catheters. The complication rate after catheter insertion was not statistically different between the two groups, but the number of unsatisfactory blocks was significantly higher in the open-end group (p less than 0.001). The closed-end catheters were easier and less painful to place, but gave a higher incidence of bloody taps. The open-end catheters caused sensory blockade to be more frequently unilateral and more frequently missed sensory segments. This resulted in a significantly higher number of open-end catheters that required replacement (p less than 0.001). Open-end catheters despite their theoretical advantages in the detection of intravenous and subarachnoid placement caused an unacceptably high incidence of unsatisfactory sensory blockade.

Adolescent↗
PubMed1980

Termination of anaesthesia--do we pay enough attention to its consequences? Haemodynamic studies following the use of piritramide, flunitrazepam and nitrous oxide anaesthesia for open heart surgery.

After completion of coronary or valve replacement surgery the haemodynamic changes due to cessation of nitrous oxide were measured. Seventy-four patients received piritramide-nitrous oxide anaesthesia. In 20 patients nitrous oxide was continued after operation and no marked haemodynamic changes occurred. However, when nitrous oxide was discontinued immediately after the operation (n=30) a significant rise in systolic arterial pressure (108+/-15 to 153+/-30 mm Hg), systolic pulmonary artery pressure (35+/-9 to 40+/-16 mm Hg), systemic vascular resistance (111 +/-26 to 148+/-44 MN.s.m-5) and rate pressure product (9,600+/-1,600 to 14,300+/-4,000) occurred. Heart rate (89+/-11 min-1), left artrial pressure (13+/---4 mm Hg) CO2 minute production (125+/-19 ml. min-1.m-2) and cardiac index (2.5+/-0.61.min-1.m-2) rose only moderately. When additional flunisternal closure to 24 patients, marked haemodynamic changes were still noted after N2O withdrawal, even though anaesthesia was prolonged. The sudden rise of arterial pressure and vascular resistance implies risks to patients with myoicardial or coronary insufficiency, therefore close monitoring is necessary, when nitrous oxide has to be stopped, to enable undelayed antihypertensive therapy.

Adult↗