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T G Costello

Publications and source records attributed to T G Costello.

9 recordsLinked to original sources
PubMed2006

Anaesthesia for robot-assisted anatomic prostatectomy. Experience at a single institution.

Robot-assisted anatomic prostatectomy is an emerging technique for management of prostate cancer It requires a coordinated approach by anaesthetist and surgeon as the surgery is performed using a modified laparoscopic technique and is potentially of long duration in a Trendelenberg position. We describe some aspects of the surgical technique and our anaesthetic approach with the first 40 cases at our institution. The mean hospital stay was 4.2 days and none of the patients required blood transfusion. A retrospective audit indicated that the use of epidural analgesia in the early postoperative period reduced opioid analgesic requirements.

Adenocarcinoma↗
PubMed2005

Plasma levobupivacaine concentrations following scalp block in patients undergoing awake craniotomy.

BACKGROUND: Levobupivacaine is an effective local anaesthetic agent for nerve blockade with less systemic toxicity than racemic bupivacaine. The safety and efficacy of levobupivacaine for scalp blockade during awake craniotomy have not been addressed previously. METHODS: Serial arterial plasma levobupivacaine concentrations following scalp blockade were measured to 2 h in 10 patients booked for awake craniotomy for epilepsy or tumour surgery. Bilateral scalp blockade providing surgical anaesthesia was achieved with a mean dose of 177 mg (2.5 mg kg(-1), range 1.6-3.2 mg kg(-1)) of levobupivacaine (0.5%, 5 mg ml(-1)) with epinephrine (5 microg ml(-1)) added immediately before the block insertion. RESULTS: The maximum measured plasma levobupivacaine concentration was 1.58 (0.44) microg ml(-1) [mean (SD)] with a mean time to peak plasma concentration of 12 (4) min. There were no episodes in any of the 10 patients of symptoms or signs suggestive of either CNS or CVS toxicity. CONCLUSIONS: This study demonstrated a relatively rapid rise of plasma levobupivacaine concentration without evidence of cardiovascular or central nervous system sequelae in a sample population of patients who may be particularly prone to perioperative seizures.

Adult↗
PubMed2005

The role of alpha2-agonists in neurosurgery.

Alpha2-agonists have been extensively used and studied in anaesthesia and intensive care medicine. A list of benefits includes anxiolysis, blood pressure stabilization, analgesia, anaesthetic sparing effects and sedation without respiratory depression or significant cognitive impairment. Fear of inadvertent hypotension, bradycardia or post-operative sedation, and the variability of the haemodynamic response to different doses or rates of administration, have meant that universal acceptance in clinical practice has not yet been seen. Recently, the actions of these agents on the alpha2-adrenoreceptor and the imidazoline receptor have been more accurately identified, helping to explain the differences between the actions of various agents. The two readily available agents, clonidine and dexmedetomidine have already been used in many different anaesthetic situations, for a wide variety of surgical procedures. We believe that both of these alpha2-agonists are useful adjuncts for the management of the neurosurgical patient during surgery, and in the intensive care unit.

Adrenergic alpha-Agonists↗
PubMed1998

Clonidine premedication decreases hemodynamic responses to pin head-holder application during craniotomy.

UNLABELLED: The aim of this study was to compare hemodynamic responses to intubation and pin head-holder application in two groups of neurosurgical patients given oral clonidine (3 microg/kg) or oral temazepam (10-20 mg) 90 min before the induction of anesthesia. Fifty patients undergoing elective craniotomy were randomized to either group. Anesthesia was induced with i.v. propofol 1500 mg/h, fentanyl 4 microg/kg, vecuronium 0.15 mg/kg, and lidocaine 1.5 mg/kg and was maintained with propofol 6 mg x kg(-1) x h(-1). Mean arterial blood pressure (MAP) and heart rate were recorded before the induction of anesthesia and before and after intubation and application of the pin head holder. Interventions required to maintain hemodynamic stability were compared between groups. Preinduction sedation scores and MAP values were similar between groups. MAP was significantly lower (P = 0.031) in the clonidine group after pin head-holder application. Interventions to stabilize MAP were not significantly different between groups (P = 0.11). We conclude that clonidine is effective in reducing the MAP increase with pin head-holder application in patients undergoing craniotomy. IMPLICATIONS: In this study, we investigated an approach to the prevention of increased blood pressure often seen during the early part of anesthesia for brain surgery. Oral clonidine was effective in reducing the mean arterial blood pressure increase resulting from pin head-holder application. Clonidine, a blood pressure-reducing drug, was given to 25 patients before anesthesia. Their blood pressure measurements were then compared with those of 25 patients not given clonidine.

Adult↗
PubMed1997

Laser prostatectomy versus transurethral resection of the prostate for benign prostatic hypertrophy: comparative changes in haemoglobin and serum sodium.

A prospective study was undertaken to examine differences in haemoglobin concentration and serum electrolytes in two patient groups undergoing surgical treatment for benign prostatic obstruction. Group one underwent conventional transurethral resection of the prostate (TURP), and group two were treated by laser ablation of the prostate (LAP). Twenty-six patients were enrolled in LAP group, 25 in the TURP group. Both patient groups had the procedure performed under epidural anaesthesia. Serial measurements of haemoglobin and sodium were performed at three time intervals: immediately preoperatively, in the recovery room and 24 hours postoperatively. A fall in serum sodium levels between the mean preoperative reading (140 mmol/l) and 24 hours post surgery (138 mmol/l) was the only statistically significant alteration sustained in the laser patients (P < 0.0001). A fall in haemoglobin from preoperative measurement to recovery room measurement of 0.71 g/l was statistically significant (P < 0.0001), but did not persist to the 24 hour postoperative time period. The TURP group demonstrated statistically significant falls in both sodium and haemoglobin levels at both postsurgery measurements. Mean serum sodium levels fell from 141 mmol/l preoperatively to 138 mmol/l (P < 0.0001) in the recovery room and 137 mmol/l (P < 0.0001) at 24 hours. Preoperative haemoglobin fell from 14.8 g/l to 13.6 g/l (P < 0.0001) in recovery and 13.7 g/l (P < 0.0001) at 24 hours.

Aged↗
PubMed1994

Anaesthesia for laser prostatectomy.

A retrospective review was undertaken to examine current anaesthetic practice in a single institution for the management of patients undergoing laser ablation of the prostate for benign prostatic hypertrophy at St Vincent's Private Hospital, Melbourne. Two groups of patients (totalling 72) were identified, one undergoing the surgery with a regional anaesthetic technique and a smaller group on full anticoagulant therapy for associated medical problems where general anaesthesia was preferred.

Anesthesia, Epidural↗