Biomedical subjects
Publications and source records attributed to R J Bray.
The stability of preservative-free morphine in plastic syringes over 36 hours in the range of concentrations commonly used in our hospital to provide continuous morphine infusions was investigated. The morphine concentration remained at 100% (SD 1.5 percent) of the control values over 36 hours and demonstrates that the concentration of morphine is not reduced with time in these circumstances.
Blood samples were taken from six children aged between 10 months and 15 years, at intervals over a period of 40 hours while they were receiving continuous morphine infusions. The plasma morphine values obtained showed similar and consistent levels 15-30 minutes after starting the infusions.
The management of cardiac arrest in adults is a well known and, in most hospitals, a well practised procedure. Similarly the resuscitation of the newborn is usually well provided for. However, cardiac arrests occurring in older children can cause difficulties.
The anaesthetic procedures used in two babies with congenital dystrophia myotonica are described, and the problems of providing anaesthesia in patients with the adult and congenital forms of the condition discussed.
Sexual harassment is against the law and can place health care facilities at substantial risk in lawsuits as well as disrupt their caring and professional atmosphere. In some cases, health care facilities are held responsible for nonemployees' harassment of employees, as well as for harassment by employees. In addition, if an employee receives benefits such as a promotion in exchange for sexual favors, the organization may be liable for discrimination against persons who did not receive such benefits. The Equal Employment Opportunity Commission has established guidelines for identifying and redressing instances of sexual harassment. They instruct health care facilities to issue a policy statement explaining to employees the institution's opposition to sexual harassment and outlining procedures for lodging a complaint. It is strongly recommended that health care facilities: Investigate complaints thoroughly, tactfully, and evenhandedly. Establish a progressive discipline schedule and administer it consistently to all employees. Document the investigatory and decision making process.
A technique is described for using morphine by continuous infusion to relieve postoperative pain in children between the ages of 1 year and 15 years. The pain relief produced by the infusion was found to be significantly better than that produced by intramuscular injections of morphine given as required in 20 children after major surgery.
Fifty-eight long-term survivors of mechanical ventilation have been traced and examined for evidence of auditory, visual, behavioural, developmental and central nervous system abnormalities. There were four children with serious neurological or intellectual handicaps, the causes of which did not seem to be related to deficiencies of their ventilator treatment but rather to events preceding ventilation or to the disease which had necessitated ventilation. There were an additional eight children who may have some intellectual damage. The occurrence of convulsions or hypoxic episodes during or preceding the period of treatment was significantly more common among the 12 children with a poor outcome, than those with a good outcome.
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Attachments to tracheostomy tubes for infant patients are described. These ensure that secure fixation in the optimal position is attained and, in the semi-permanent tracheostomy, prevent accidental occlusion of the tracheostome.
A description of the pathology, clinical presentation and management of congenital diaphragmatic hernia is given together with the results obtained in Newcastle during the last seven years. Some suggestions are made for improved management.
The presence of a lateral pharyngeal pouch may cause difficulty in recognising the glottis when awake intubation is undertaken. This is mainly because the orifice may open and close during phonation and therefore be mistaken for the glottis. A case is described and some aspects of relevance to the anaesthetist are discussed.