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R M Tackley

Publications and source records attributed to R M Tackley.

9 recordsLinked to original sources
PubMed1994

A standard set of terms for critical incident recording?

The Anaesthetic Specialty Working Group of the Clinical Terms Project has been creating clinical terms for inclusion in the Read clinical classification. It is the intention to include terms to describe critical incidents. Many difficulties were encountered and these are discussed. The current definitions of a critical incident in the anaesthetic literature are too wide to allow a circumscribed set of terms to be generated. The interpretation of a critical incident is not only subjective but also requires a great deal of contextual information to describe it accurately. A method of critical incident reporting using the terms that will be contained within the enhanced Read clinical classification is proposed. These terms may be useful in the construction of a nationwide critical incident register.

Anesthesiology↗
PubMed1993

Why do anaesthetists need codes?

With the increasing availability of information technology in hospitals and the introduction of medical audit and resource management, there is a proliferation of anaesthetic data collection systems. The amount of data recorded varies from a complete anaesthetic record to a small subset of it. Most systems hold data in coded form for reasons of accuracy and compactness. Unfortunately, all the coding systems are different, making comparisons between different centres difficult. We propose that there is a need to develop a standard national system for coding anaesthetic terms.

Anesthesiology↗
PubMed1990

Study of the possible interaction between fentanyl and propofol using a computer-controlled infusion of propofol.

A computer-controlled infusion of propofol designed to achieve a target blood concentration of propofol 3 microgram ml-1 was used to investigate the possibility of an interaction between propofol and fentanyl in 32 patients undergoing body surface surgery. In 16 patients who were not receiving a neuromuscular blocker during maintenance anaesthesia with 67% nitrous oxide, there were no significant differences in blood concentrations of propofol between eight patients who received fentanyl 5 micrograms kg-1 before induction of anaesthesia, and eight patients who did not. In a further 16 patients who received vecuronium during maintenance anaesthesia with 67% nitrous oxide, there were no significant differences in blood propofol concentrations between eight patients who received fentanyl 5 micrograms kg-1 before induction of anaesthesia, and eight patients who did not. Fentanyl administered i.v. immediately before a computer-controlled infusion of propofol resulted in more satisfactory anaesthetic conditions than when fentanyl was not used, but did not significantly prolong the recovery time.

Adult↗
PubMed1989

Computer controlled infusion of propofol.

A computer controlled infusion pump was used to deliver propofol to two groups of eight patients undergoing body surface surgery. The patients were premedicated with morphine sulphate i.m. and anaesthesia was supplemented with 66% nitrous oxide in oxygen. Patients in group 1 breathed spontaneously, whereas patients in group 2 underwent artificial ventilation to a normal PaCO2. The computer program was designed to achieve and maintain a blood concentration of propofol 3 micrograms ml-1 as rapidly as possible, basing calculations on a three-compartment pharmacokinetic model. Mean blood propofol concentrations were found to be close to the predicted target from 10 to 120 min in group 1, but were 5-20% higher from 20 min in group 2.

Adult↗
PubMed1988

Induction and maintenance of propofol anaesthesia. A manual infusion scheme.

A simple, manually controlled infusion scheme for continuous administration of propofol was derived by simulation of a computer algorithm designed to achieve a predetermined blood concentration of propofol within 2 minutes and to maintain a constant blood level for the duration of surgery. The manual infusion scheme for a target blood propofol concentration of 3 micrograms/ml, consisted of a loading dose of 1 mg/kg followed immediately by an infusion of 10 mg/kg/hour for 10 minutes, 8 mg/kg/hour for the next 10 minutes and 6 mg/kg/hour thereafter. An overall mean blood propofol concentration of 3.67 micrograms/ml was achieved within 2 minutes and maintained stable for the subsequent 80-90 minutes of surgery. The decrease of systolic and diastolic arterial pressures at induction was much less than that previously described after larger induction doses of propofol and there was a negligible haemodynamic response to laryngoscopy and intubation or to the subsequent surgery. The quality of induction and maintenance of anaesthesia was satisfactory in every patient.

Adult↗
PubMed1988

Alkalinized bupivacaine and adrenaline for epidural caesarean section. A comparison with 0.5% bupivacaine.

Twenty-four mothers received either 0.5% bupivacaine (group 1, n = 14), or alkalinized 0.5% bupivacaine and 1 in 200,000 adrenaline (group 2, n = 10), as an epidural local anaesthetic for elective lower segment Caesarean section in a randomised, double blind study. The two groups were prepared for surgery according to an identical technique. Onset of analgesia to pinprick was significantly faster in group 2 (p less than 0.02). Group 1 required additional analgesia during surgery significantly more often than those in group 2 (p = 0.04). Significantly more patients in group 2 were ready for surgery by the time limit for the study (45 minutes, p = 0.002). Onset of motor blockade was significantly faster in group 2 (p = 0.01). There were no significant differences between the two groups with regard to duration of surgery, or Apgar scores at 1 and 5 minutes. Alkalinized 0.5% bupivacaine and adrenaline was superior to 0.5% bupivacaine for epidural Caesarean section.

Anesthesia, Epidural↗
PubMed1985

Assessment of bleeding in eye surgery.

A new method for assessing microhaemorrhage in eye surgery was used in 16 patients for cataract extraction. It was shown that bleeding was greatest in the first five minutes and that it correlated with the surgeon's clinical estimate of blood loss. The method was used to assess the effect of two different general anaesthetic induction regimens on intraoperative bleeding.

Aged↗